Antidepressants in children and adolescents--changes in utilisation after safety warnings.
BACKGROUND
Antidepressants, in particular selective serotonin reuptake inhibitors, are one of the most commonly used classes of psychotropic drug in children and adolescents. Beginning in June 2003, evidence emerged suggesting that antidepressants may increase risk of suicidal behaviour in young people. This evidence was accompanied by national and international guidelines cautioning against use of many antidepressants in young people. This study aimed to assess whether these safety warnings have impacted upon antidepressant utilisation rates.


METHODS
This study was based at a metropolitan health service incorporating children's and adult hospitals. Total service utilisation of antidepressants was extracted from pharmacy software for the period January 2002 to December 2005. Monthly utilisation rates were computed for adults and children's services as defined daily doses (DDD) per occupied bed days. Changes in utilisation over time were examined for children and adults.


RESULTS
There was a significant relationship between time and antidepressant utilisation in children and adolescents, where antidepressant use decreased over time (R = 0.474; t = -3.66; p < 0.01), and in particular, use of SSRIs (R = 0.461; t = -3.52; p < 0.01). In contrast, use of SSRIs (R = 0.587; t = 4.91; p < 0.001) and all antidepressants (R = 0.327; t = 2.35; p < 0.05) increased over time in adults.


CONCLUSIONS
National and international warnings about safety of antidepressants in children and adolescents appear to have influenced local utilisation of these medications in young people but not in adults. Further research is required to determine optimal utilisation rates.
Dean
Angela J
AJ
Kids in Mind Research, Mater Child & Youth Mental Health Service, Brisbane, Australia. Angela.Dean@mater.org.au
Hendy
Anna
A
McGuire
Treasure
T
D000293:Adolescent; D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D002648:Child; D016208:Databases, Factual / Q000706:statistics & numerical data; D004348:Drug Labeling / Q000331:legislation & jurisprudence; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D017723:Drug Utilization Review / Q000331:legislation & jurisprudence / Q000379:methods* / Q000706:statistics & numerical data; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use; D006077:Government Agencies / Q000331:legislation & jurisprudence; D006801:Humans; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors
D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline