Study: Child Antidepressant Use Down
But Decline Corresponds With Suicide Increase
April 2, 2007 -- Prescriptions for antidepressants dropped dramatically
among children and teens following public warnings about deadly side effects,
but now suicides are up, researchers say.
The findings highlight the critical role of mass media in driving medical
care, and they are especially troubling in light of reports showing an increase
in actual suicides in children and teens at the same time antidepressant use
was declining because of fear the drugs may cause an increase in suicidal
behaviors, a study co-author tells WebMD.
In 2004, for the first time in a decade, suicide rates among children and
adolescents rose instead of declining. That was also the year the FDA held
highly publicized hearings that led to stronger warnings about suicide risk on
selective serotonin reuptake inhibitor (SSRI) antidepressants like Prozac,
Paxil, Zoloft, and Celexa.
The move followed an FDA warning of an increased risk of suicidal attempts,
thoughts, and behaviors among children and teens who took SSRIs. That warning
was issued in the fall of 2003, and it was also widely publicized.
“Mainstream media had a very large impact on prescription practices,” says
Amir Kalali, MD, of the private research group Quintiles Transnational. “There
hasn’t been much thought given to quantifying the impact of mass media [on
health care practices], but we hope this paper gets the dialogue going.”
16% Decline in 6 Months
Kalali, Charles Nemeroff, MD, PhD, of Emory University in Atlanta, and
colleagues analyzed prescription data and physician surveys detailing
prescription practices to identify trends in antidepressant use among children
The data they analyzed included more than half -- 55% -- of all U.S. retail
pharmacy prescriptions, including private payers, Medicaid, and cash
The physician survey involved about 3,400 office-based physicians across 29
The examination of antidepressant prescription practices from 2000 to 2005
showed a sharp decline in prescriptions to children and teenagers beginning in
Between April 2002 and February 2004, antidepressant prescriptions among
kids and teens increased by an average of 0.79% a month. Between February 2004
and July 2004 prescriptions declined by an average of 4% a month.
Prescriptions declined by 5% during the first quarter of 2004 and 11% in the
second quarter of 2004. Rates stabilized after July and have just begun to move
upward, according to study co-author Elisa Cascade, MBA, vice president of
The researchers also confirmed a shift away from generalized care and toward
more specialized care by psychiatrists and other mental health professionals
for depressed patients 18 and younger.
While this sounds like a good thing, it may mean fewer depressed kids and
teens are being treated because of a shortage of pediatric psychiatrists,
“Anytime there are safety issues associated with a medication, primary care
physicians are going to be less confident about prescribing that medication,”
If generalists are referring young patients to specialists but there aren’t
enough specialists to go around, that could mean patients get no care at all,
The study is published in the April issue of the journal Archives of