Diagnosis and treatment of depression in children and adults dropped significantly in the wake of a 2003 Food and Drug Administration public health advisory regarding the risk of suicidality among children taking antidepressants, according to a review of claims data from 1999 to 2007.
After steady increases in depression diagnoses among children between 1999 and 2004, the diagnoses of depression began to decline in 2005, dropping to 3.5 per 1,000 enrollees in 2007, nearly back to 1999 levels.
Although the October 2003 FDA warning related only to children, the researchers found a “spillover” effect in adults. Given historical trends, the rate of depression diagnoses should have been about 20.3 per 1,000 enrollees in 2007; however, the actual observed rate was just 12.4 (Arch. Gen. Psychiatry 2009;66:633-9).
Anne M. Libby, Ph.D., and her colleagues at the University of Colorado, Denver, examined the diagnosis of depression, antidepressant use for depression, use of psychotherapy after depression diagnosis, and the use of antidepressant alternatives after depression diagnosis for the periods before and after the FDA public health advisory was issued.
The findings are based on a nationally representative database of claims from PHARMetrics, a unit of IMS, Inc., which includes more than 55 million patients enrolled in managed care plans. The researchers created a cohort of new episodes of depression with a total of 643,313 individual patients. The cohort included 792,807 episodes of diagnosis and possible treatment of depression. The episodes of care include 91,748 pediatric cases (aged 5-18 years at time of diagnosis), 70,311 young adult cases (aged 19-24), and 630,748 adult cases (aged 25-89). The researchers analyzed trends in these cases from July 1999 to June 2007.
The researchers also identified changes in the type of providers who diagnosed depression. In the post-advisory period from 2004 through June 2007, the case finding of depression decreased significantly among both pediatricians and primary care providers.
During the post-advisory period, diagnoses of new episodes of depression by primary care providers also dropped 37% for young adults and 29% for adults. “Non-psychiatrist other mental health providers” was the only provider type that increased case finding following the 2003 FDA advisory, the researchers found. The trend was small but was seen across all age groups, according to the study.
Prescriptions for selective serotonin reuptake inhibitors (SSRIs) also declined following the 2003 FDA warning. Prescriptions for SSRIs within 30 days of the new depression episode fell by 10% for children and 15% for adults from the post-advisory period through 2007. But the drop in SSRI use generally did not mean that depressed patients were getting alternative treatments, the researchers found.
The researchers reported receiving unrestricted, investigator-initiated research grants from Eli Lilly and Company, Forest Pharmaceuticals Inc., Lundbeck, and the American Foundation for Suicide Prevention.