Harvard Mental Health Letter

Commentary: Children, depression, and the FDA

Commentary

Children, depression, and the FDA

In October 2003, the U.S. Food and Drug Administration (FDA) cautioned the public that antidepressants might increase the risk of suicide in children. A study published in June 2007 in the American Journal of Psychiatry suggests one possible unintended consequence of that policy: Children with depression may be less likely to get diagnosed and treated.

Using claims data from 47 million insured people, researchers in Denver and Pittsburgh identified about 65,000 children (ages 5 to 18) who were diagnosed with depression over a seven-year period. The study authors analyzed information about the patients' diagnoses, their treatments (whether a drug or psychotherapy), and who was treating them (for example, pediatricians, other primary care doctors, or mental health specialists). They compared trends before and after the October 2003 public health advisory.

In the years 1999 to 2004, the data showed a steady increase in the number of depression diagnoses and a parallel increase in the number of antidepressant prescriptions. Then there was an abrupt about-face. In 2005, the rate of diagnosis overall went down and — not surprisingly given the new cautions — a smaller percentage of children with depression were given an antidepressant drug to treat it. Furthermore, through 2004, pediatricians and other primary care physicians had written most antidepressant prescriptions for children. In 2005, psychiatrists were seen to be doing more of the prescribing.

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