Rising prevalence of antidepressants among US youths.
OBJECTIVE
To examine changes in antidepressant (ATD) prevalence and the sociodemographic and clinical correlates of ATD use among youths who are treated in community practice settings.


METHODS
A retrospective study was undertaken using large data sets from 3 US sites. Outpatient prescription and clinical service records of youths who were aged 2 to 19 and enrolled in Midwestern Medicaid (MWM) and mid-Atlantic Medicaid (MAM) state programs and a group-model health maintenance organization (HMO) were organized into seven 1-year cross-sectional data sets from 1988 through 1994 to evaluate ATD utilization patterns.


RESULTS
In 1994, ATD prevalence per 1000 youths was 19.10 (MWM), 17.78 (MAM), and 12.85 (HMO), which represented a consistent increase in prevalence from 1988-1994: 2.9-fold (MWM), 4.6-fold (MAM), and 3.6-fold (HMO). Despite the rapidly expanding use of selective serotonin reuptake inhibitors prescribed mainly for depression, more than half of ATD use in 1994 was still attributable to tricyclic antidepressants prescribed mainly for attention-deficit/hyperactivity disorder. ATD prevalence was generally predominant among 10- to 14-year-old boys and among 15- to 19-year-old girls. In the Medicaid populations, 42% (MAM) and 72% (MWM) of ATD-treated youths had primary care services, whereas the bulk of the remainder had psychiatric services. Attention-deficit/hyperactivity disorder followed by depression led the physician-reported primary care diagnoses associated with ATD use, whereas that diagnostic rank order was reversed for youths who received psychiatric services.


CONCLUSIONS
ATD treatments among youths substantially increased in the 1990s. This was generated primarily by primary care providers, and thus evaluations of the outcome of ATD treatment need to target primary care in addition to psychiatric providers. Longitudinal study designs are needed to evaluate the use of ATDs in youths in regard to the duration of treatment, combination medications, and the reasons for treatment.
Zito
Julie Magno
JM
School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA. jzito@rx.umaryland.edu
Safer
Daniel J
DJ
DosReis
Susan
S
Gardner
James F
JF
Soeken
Karen
K
Boles
Myde
M
Lynch
Frances
F
D000275:Adjustment Disorders / Q000188:drug therapy; D000293:Adolescent; D000367:Age Factors; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D000928:Antidepressive Agents