Friday, January 20, 2006

Antidepressants for Children is on the Rise

Are children being inappropriately prescribed antidepressants? The number of U.S. children and teens who were diagnosed with depression more than doubled between 1995 & 2002. The overall increase in adolescent patients is likely due to the growing awareness of depression in children, a problem that’s been historically under-diagnosed. Also the use of antidepressant drugs rose and the use of psychotherapy and/or counseling declined. The number of clinician visits by children and adolescents being seen for depression more than doubled. However, mental health counseling including psychotherapy dropped from 83 percent to 68 percent. Analysis also showed that between 42 percent and 52 percent of all adolescent patient visits involving medication did not include counseling. Antidepressants prescribed to seven to 17 year old patients rose from 47 percent in 1995-1996 to 52 percent in 2001-2002, including increases in the off-label use of selective serotonin reuptake inhibitors (SSRI’S), which accounts for 76 percent of antidepressants prescribed to adolescents in 1995-1996 and 81 percent in 2001-2002. This was reported by Stanford researchers in the December issue of Journal of Adolescent Health. The observation of the increasingly prevalent off label use of SSRI’s as well as possible inappropriate use of medications in substitution of psychotherapy/mental health counseling as first line therapy, raises concerns about physicians adherence to evidence based medicine. As drug use increased, counseling decreased. The prevalence of psychotherapy remained above 80 percent from 1995-1998, but then it dropped significantly to 54 percent in 1999-2000 before rising at 68 percent at the end of the study period. Researchers say the findings point to possible instances of inappropriate prescribing to children. While guidelines call for children to be treated with either mental health counseling or a combination of counseling and medication, the study found a trend of antidepressants replacing talk therapy. Additionally, only Prozac , which jumped 100 percent in use over an eight year period, had been specifically approved for patients younger than 18. But after 1995, other antidepressants rose with children receiving prescriptions for them on an off label basis. These trends raise concerns regarding the widespread off label use of antidepressants lacking reliable evidence of safety and efficacy for use in children and adolescents.
Study author, Dr. Jun Ma of the Stanford University School of Medicine, Palo Alto, Ca., says it’s not clear why the use of antidepressants increased during the study. But she feels that it’s likely a combination of factors including widespread drug advertising, perceptions that drugs are more effective than therapy, and the fact that taking medication is more convenient than counseling. Whether or not prescription use will continue to rise is now in question. Recently, the FDA directed manufacturers of all antidepressants to place a “black box” label on their products, warning of the increased risk of suicidal behavior that has been inked to certain medications. Dr. Ma said it will be important to track how this change affects prescribing trends. Ma makes a note that the labels are not intended to scare doctors and patients away from antidepressants because they can be an important part in the treatment of depression in children. Researchers point out that Prozac, along with talk therapy, should be the first choice antidepressant for children, and only if that fails should other drugs be considered Prozac was the most commonly prescribed antidepressant, with Zoloft and Paxil close behind, which are not FDA approved for children.
Clinical guidelines from the American Academy of Child and Adolescent Psychiatry recommends that psychotherapy be used on all children and adolescents. Antidepressants, in combination with psychotherapy/mental health counseling should be prescribed to those with severe psychotherapy-resistant symptoms only. Depression affects up to 8 percent of U.S. children and is a major risk factor for suicide, which is the third leading cause of death among teens. Recently, the American Psychiatric Association reported that antidepressant use among adolescents had dropped by almost 20 percent after the FDA’s decision to put warnings on prescriptions.

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