title: Antidepressant prescribing in Irish children: secular trends and international comparison in the context of a safety warning.
abstract: BACKGROUND
  In 2003, the Irish Medicines Board (IMB) warned against the treatment of childhood depression with selective serotonin reuptake inhibitors (SSRIs) due to increased risk of suicide. This study examined the effect of this warning on the prevalence of anti-depressants in Irish children and compared age and gender trends and international comparisons of prescription rates.
  
  
  METHODS
  A retrospective cohort study of the Irish Health Service Executive (HSE) pharmacy claims database for the General Medical Services (GMS) scheme for dispensed medication. Data were obtained for 2002-2011 for those aged ≤ 15 years. Prevalence of anti-depressants per 1000 eligible population, along with 95% confidence intervals, were calculated. A negative binomial regression analysis was used to investigate trends and compare rates across years, sex and age groups (0-4, 5-11, 12-15 years). International prescribing data were retrieved from the literature.
  
  
  RESULTS
  The prevalence of anti-depressants decreased from 4.74/1000 population (95% CI: 4.47-5.01) in 2002 to 2.61/1000 population (95% CI: 2.43-2.80) in 2008. SSRI rates decreased from 2002 to 2008. Prescription rates for contra-indicated SSRIs paroxetine, sertraline and citralopram decreased significantly from 2002 to 2005, and, apart from paroxetine, only small fluctuations were seen from 2005 onwards. Fluoxetine was the most frequently prescribed anti-depressant and rates increased between 2002 and 2011. Anti-depressant rates were higher for younger boys and older girls. The Irish prevalence was lower than the US, similar to the U.K. and higher than Germany and Denmark.
  
  
  CONCLUSIONS
  The direction and timing of these trends suggest that medical practitioners followed the IMB advice.
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland. osullk14@tcd.ie.
authors.forename: K
authors.initials: K
authors.lastname: O'Sullivan
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland. fionaboland@rcsi.ie.
authors.forename: F
authors.initials: F
authors.lastname: Boland
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland. udoreulbach@rcsi.ie.|Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Trinity College Dublin, Dublin 2, Ireland. udoreulbach@rcsi.ie.
authors.forename: U
authors.initials: U
authors.lastname: Reulbach
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Motterlini
authors.affiliation: Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Trinity College Dublin, Dublin 2, Ireland. dkelly23@tcd.ie.
authors.forename: D
authors.initials: D
authors.lastname: Kelly
authors.affiliation: Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland. bennettk@tcd.ie.
authors.forename: K
authors.initials: K
authors.lastname: Bennett
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland. tomfahey@rcsi.ie.
authors.forename: T
authors.initials: T
authors.lastname: Fahey
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007494:Ireland; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012737:Sex Factors
chemical_list: D000928:Antidepressive Agents; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors