title: Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study.
abstract: OBJECTIVE
  To investigate if the widely publicized warnings in 2003 from the US Food and Drug Administration about a possible increased risk of suicidality with antidepressant use in young people were associated with changes in antidepressant use, suicide attempts, and completed suicides among young people.
  
  
  METHODS
  Quasi-experimental study assessing changes in outcomes after the warnings, controlling for pre-existing trends.
  
  
  METHODS
  Automated healthcare claims data (2000-10) derived from the virtual data warehouse of 11 health plans in the US Mental Health Research Network.
  
  
  METHODS
  Study cohorts included adolescents (around 1.1 million), young adults (around 1.4 million), and adults (around 5 million).
  
  
  METHODS
  Rates of antidepressant dispensings, psychotropic drug poisonings (a validated proxy for suicide attempts), and completed suicides.
  
  
  RESULTS
  Trends in antidepressant use and poisonings changed abruptly after the warnings. In the second year after the warnings, relative changes in antidepressant use were -31.0% (95% confidence interval -33.0% to -29.0%) among adolescents, -24.3% (-25.4% to -23.2%) among young adults, and -14.5% (-16.0% to -12.9%) among adults. These reflected absolute reductions of 696, 1216, and 1621 dispensings per 100,000 people among adolescents, young adults, and adults, respectively. Simultaneously, there were significant, relative increases in psychotropic drug poisonings in adolescents (21.7%, 95% confidence interval 4.9% to 38.5%) and young adults (33.7%, 26.9% to 40.4%) but not among adults (5.2%, -6.5% to 16.9%). These reflected absolute increases of 2 and 4 poisonings per 100,000 people among adolescents and young adults, respectively (approximately 77 additional poisonings in our cohort of 2.5 million young people). Completed suicides did not change for any age group.
  
  
  CONCLUSIONS
  Safety warnings about antidepressants and widespread media coverage decreased antidepressant use, and there were simultaneous increases in suicide attempts among young people. It is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA christine_lu@harvardpilgrim.org.
authors.forename: Christine Y
authors.initials: CY
authors.lastname: Lu
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Lakoma
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Madden
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Rusinak
authors.affiliation: Group Health Research Institute, Seattle, WA, USA Department of Health Services Research, University of Washington, Seattle, WA, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.affiliation: Group Health Research Institute, Seattle, WA, USA Mental Health Research Network.
authors.forename: Gregory
authors.initials: G
authors.lastname: Simon
authors.affiliation: Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Ahmedani
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, OR, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Clarke
authors.affiliation: The Division of Research, Kaiser Permanente Medical Care Program Northern California, Oakland, CA, USA.
authors.forename: Enid M
authors.initials: EM
authors.lastname: Hunkeler
authors.affiliation: Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
authors.affiliation: The Center for Health Research Southeast, Kaiser Permanente Georgia, Atlanta, GA, USA.
authors.forename: Ashli
authors.initials: A
authors.lastname: Owen-Smith
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA.
authors.forename: Marsha A
authors.initials: MA
authors.lastname: Raebel
authors.affiliation: HealthPartners Institute for Education and Research, Bloomington, MN, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rossom
authors.affiliation: Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Coleman
authors.affiliation: Center for Applied Health Research, Central Texas Veterans Health Care System jointly with Scott & White Healthcare, Temple, TX, USA.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000506:poisoning; D015331:Cohort Studies; D004348:Drug Labeling; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008402:Mass Media; D008875:Middle Aged; D011358:Product Surveillance, Postmarketing; D013405:Suicide; D014481:United States; D014486:United States Food and Drug Administration; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents