Healthy Skepticism Library item: 11593

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Publication type: Journal Article

Valuck RJ, Libby AM, Orton HD, Morrato EH, Allen R, Baldessarini RJ.
Spillover effects on treatment of adult depression in primary care after FDA advisory on risk of pediatric suicidality with SSRIs.
Am J Psychiatry 2007 Aug; 164:(8):1198-205
http://ajp.psychiatryonline.org/cgi/content/full/164/8/1198

Abstract:

OBJECTIVE: In 2003, the U.S. Food and Drug Administration (FDA) issued a public health advisory about the risk of suicidality in pediatric patients taking selective serotonin reuptake inhibitors (SSRIs) for depression, and in 2005, the agency mandated a black box warning and medication guide indicating that pediatric and adult patients may be at risk. The authors examine the effects of this pediatric policy on treatment of adult depression in the community.

METHOD: An adult cohort with newly diagnosed episodes of depression was created from a large national integrated claims database of managed care plans from October 1998 to September 2005 (N=475,838 unique episodes). Time-series analyses were used to compare the post-FDA advisory trends to the trends during the 5 years preceding the advisory.

RESULTS: The rate of diagnosed depression was significantly lower after the advisory than would have been expected on the basis of the preadvisory historical trend. The average percentage of adults with new (versus recurrent) depressive episodes was 88.6% in the preadvisory period (declining at an annual rate of 1.69%), and it decreased significantly to 77.5% (declining more rapidly, at an annual rate of 7.70%). The percentage of adults with depression who did not receive an antidepressant increased from an average of 20% (declining at 0.45% annually) before the policy action to an average of 30% (increasing at an annual rate of 20.6%). The data did not show any compensatory increases in psychotherapy or prescription of atypical antipsychotics or anxiolytics.

CONCLUSIONS: The FDA advisory had a significant spillover effect into community treatment for adults with depression, despite the focus of the policy on pediatric patients.

Keywords:
Publication Types: Research Support, Non-U.S. Gov't MeSH Terms: Adolescent Adult Advisory Committees/statistics & numerical data Age Factors Aged Aged, 80 and over Child Depressive Disorder/diagnosis Depressive Disorder/drug therapy* Depressive Disorder/epidemiology Drug Labeling/statistics & numerical data* Health Policy/legislation & jurisprudence Humans Managed Care Programs/statistics & numerical data Middle Aged Physician's Practice Patterns Prescriptions, Drug/statistics & numerical data Risk Assessment/statistics & numerical data Seasons Serotonin Uptake Inhibitors/adverse effects* Serotonin Uptake Inhibitors/therapeutic use* Specialties, Medical/statistics & numerical data Suicide/psychology Suicide/statistics & numerical data* United States/epidemiology United States Food and Drug Administration/legislation & jurisprudence Substances: Serotonin Uptake Inhibitors