title: A 10-year analysis of the effects of media coverage of regulatory warnings on antidepressant use in The Netherlands and UK.
abstract: BACKGROUND
  In 2003-2004 and 2007-2008, the regulatory banning of SSRI use in pediatrics and young adults due to concerns regarding suicidality risk coincided with negative media coverage. SSRI use trends were analyzed from 2000-2010 in the Netherlands (NL) and the UK, and whether trend changes might be associated with media coverage of regulatory warnings.
  
  
  METHODS
  Monthly SSRIs sales were presented as DDDs/1000 inhabitants/day. SSRI-use trends were studied using time-series segmented regression analyses. Timing of trend changes was compared with two periods of media coverage of warnings. Annual Dutch SSRI prescription data were analyzed by age group.
  
  
  RESULTS
  Trend changes in SSRI use largely corroborated with the periods of media coverage of warnings. British SSRI use declined from 3.9 to 0.7 DDDs/month (95%CI 3.3;4.5 & 0.5;0.9, respectively) before the first warning period (2003-2004). A small decrease of -0.6 DDDs/month (-1.2; -0.05) was observed in Dutch SSRI use shortly after 2003-2004. From 2007-2008, British SSRI use stabilized, whilst Dutch SSRI use diminished to -0.04 DDDs/month (-0.4;0.3). Stratified analyses showed a rapid decrease of -1.2 DDDs/month (-2.1; -1.7) in UK paroxetine use before 2003-2004, but only a minimal change in Dutch paroxetine use (-0.3 DDDs/month -0.8;0.2). Other SSRI use, especially (es)citalopram, increased during 2003-2004 in both countries. Significant reductions in Dutch paroxetine use were observed in pediatrics, adolescents, and young adults after 2003-2004.
  
  
  CONCLUSIONS
  Changes in SSRI use (NL & UK) were associated with the timing of the combined effect of media coverage and regulatory warnings. Our long-term assessment illustrates that changes in SSRI use were temporal, drug-specific and more pronounced in pediatrics and young adults. The twofold increase in SSRI use over one decade indicates that regulatory warnings and media coverage may come and go, but they do not have a significant impact on the overall upward trend of SSRI use as a class in both countries.
authors.affiliation: Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Hernandez
authors.forename: Aukje K
authors.initials: AK
authors.lastname: Mantel-Teeuwisse
authors.forename: Ghislaine J M W
authors.initials: GJ
authors.lastname: van Thiel
authors.forename: Svetlana V
authors.initials: SV
authors.lastname: Belitser
authors.forename: Jan
authors.initials: J
authors.lastname: Warmerdam
authors.forename: Vincent
authors.initials: V
authors.lastname: de Valk
authors.forename: Jan A M
authors.initials: JA
authors.lastname: Raaijmakers
authors.forename: Toine
authors.initials: T
authors.lastname: Pieters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003146:Communications Media / Q000266:history; D011307:Drug Prescriptions / Q000191:economics / Q000266:history; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009426:Netherlands; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors