Antidepressants in children and adolescents - Changes in utilisation after safety warnings

Background: Antidepressants, in particular selective serotonin reuptake inhibitors, are one of the most commonly used classes of psychotropic drug in children and adolescents. Beginning in June 2003, evidence emerged suggesting that antidepressants may increase risk of suicidal behaviour in young people. This evidence was accompanied by national and international guidelines cautioning against use of many antidepressants in young people. This study aimed to assess whether these safety warnings have impacted upon antidepressant utilisation rates. 

Method: This study was based at a metropolitan health service incorporating children's and adult hospitals. Total service utilisation of antidepressants was extracted from pharmacy software for the period January 2002 to December 2005. Monthly utilisation rates were computed for adults and children's services as defined daily doses (DDD) per occupied bed days. Changes in utilisation over time were examined for children and adults. 

Results: There was a significant relationship between time and antidepressant utilisation in children and adolescents, where antidepressant use decreased over time (R = 0.474; t = -3.66; p < 0.01), and in particular, use of SSRIs (R = 0.461; t = -3.52; p < 0.01). In contrast, use of SSRIs (R = 0.587; t = 4.91; p < 0.001) and all antidepressants (R = 0.327; t = 2.35; p < 0.05) increased over time in adults. 

Conclusions: National and international warnings about safety of antidepressants in children and adolescents appear to have influenced local utilisation of these medications in young people but not in adults. Further research is required to determine optimal utilisation rates.