title: Trends in depression and antidepressant prescribing in children and adolescents: a cohort study in The Health Improvement Network (THIN).
abstract: BACKGROUND
  In 2003, the Committee on Safety of Medicines (CSM) advised against treatment with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine in children, due to a possible increased risk of suicidal behaviour. This study examined the effects of this safety warning on general practitioners' depression diagnosing and prescription behaviour in children.
  
  
  RESULTS
  We identified a cohort of 1,502,753 children (<18 y; registered with GP for >6 m) in The Health Improvement Network (THIN) UK primary care database. Trends in incidence of depression diagnoses, symptoms and antidepressant prescribing were examined 1995-2009, accounting for deprivation, age and gender. We used segmented regression analysis to assess changes in prescription rates. Overall, 45,723 (3%) children had ≥ 1 depression-related entry in their clinical records. SSRIs were prescribed to 16,925 (1%) of children. SSRI prescription rates decreased from 3.2 (95%CI:3.0,3.3) per 1,000 person-years at risk (PYAR) in 2002 to 1.7 (95%CI:1.7,1.8) per 1,000 PYAR in 2005, but have since risen to 2.7 (95%CI:2.6,2.8) per 1,000 PYAR in 2009. Prescription rates for CSM-contraindicated SSRIs citalopram, sertraline and especially paroxetine dropped dramatically after 2002, while rates for fluoxetine and amitriptyline remained stable. After 2005 rates for all antidepressants, except paroxetine and imipramine, started to rise again. Rates for depression diagnoses dropped from 3.0 (95%CI:2.8,3.1) per 1,000 PYAR in 2002 to 2.0 (95%CI:1.9,2.1) per 1,000 PYAR in 2005 and have been stable since. Recording of symptoms saw a steady increase from 1.0 (95%CI:0.8,1.2) per 1,000 PYAR in 1995 to 4.7 (95%CI:4.5,4.8) per 1,000 PYAR in 2009.
  
  
  CONCLUSIONS
  The rates of depression diagnoses and SSRI prescriptions showed a significant drop around the time of the CSM advice, which was not present in the recording of symptoms. This could indicate caution on the part of GPs in making depression diagnoses and prescribing antidepressants following the CSM advice.
authors.affiliation: Department of Primary Care and Population Health, University College London, London, United Kingdom. linda.wijlaars.10@ucl.ac.uk
authors.forename: Linda P M M
authors.initials: LP
authors.lastname: Wijlaars
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012737:Sex Factors
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors