Sept. 22, 2004 — Far fewer kids are taking antidepressants today, on the heels of strong FDA warnings of suicide risk, a new survey shows.

Over 20% fewer children and adolescents are taking antidepressants compared with late 2003, says Glen Stettin, MD, a vice president with Medco Health Solutions Inc., one of the country’s leading pharmacy benefits managers.

Medco commissioned the survey of 3.5 to 4 million adolescents covered by insurance from 2002 to 2004.

In October 2003, the FDA issued a warning that children and teens that take antidepressant drugs to treat major depression may face a higher suicide risk. And in February 2004, an FDA advisory panel recommended stronger warnings about the risk of suicide in kids who take antidepressant drugs.

Before advisories about antidepressants and suicide risk began to surface, more than 105,000 kids in the study were taking an antidepressant. By March 2004, 18% fewer children and teens were taking the drugs; in June 2004, the number fell by 5% more.

“It’s certainly an abrupt change, a dramatic change, in use of these drugs,” Stettin tells WebMD. “We saw the same drop-off when warnings came out about hormone replacement therapy.”

However, children’s overall use of medications — and the drugs’ cost — continued to increase, the report shows. From January 2000 to December 2003:

• Spending for behavioral medications — like medications for obsessive-compulsive disorder and anxiety — rose by 77% (due to increased costs and increased use, the report states).
• Spending on behavioral medications was higher than for both antibiotics and asthma drugs. (These are traditionally high-use drugs among children.)
• Children’s overall behavioral drug use increased by 20%, outpaced only by the increase in the number of kids taking drugs for intestinal problems — 28%.
• Spending for attention deficit hyperactivity disorder (ADHD) medications increased by 183% for children overall and 369% for children under age 5.
• 49% more preschoolers were taking ADHD drugs.
• Spending on antidepressants for kids grew by 25%, while use of these drugs rose by 27%.

It’s a trend seen in adults, too. “More people in every age group are using more prescription drugs,” Stettin tells WebMD. “But it seems that when there are safety concerns for these drugs, people pay attention.”

Another trend: Over the past few years, there’s been a very dramatic shift in use of antibiotics. Whereas there had been a continuous rise, the numbers have flattened out, says Stettin. “People seem to have gotten the message that unless you’re treating bacterial infections, you shouldn’t take antibiotics.”

For Some Kids, Antidepressants May Be Necessary

“My biggest concern is that kids who could benefit from antidepressants won’t get them because of fear,” says R. Andrew Harper, MD, professor of psychiatry and specialist in child psychiatry at the University of Texas Health Science Center in Houston.

“A lot of families are beginning to question whether children should use these medications,” Harper tells WebMD. “But if families won’t allow their child to try the drugs, kids who could benefit won’t have the opportunity to benefit from them. The kids themselves may be frightened of the drugs. My worry is, suicide does occur with depression. These kids need to be treated effectively.”

What should parents of a depressed child do?

“You need to have a discussion with the physician about risks and benefits of antidepressants,” Harper advises. “You should also be working with a doctor or psychiatrist who is willing to take time to have that discussion.”

If everyone agrees that the child needs an antidepressant, parents should work closely with the physician, take the child for weekly follow-up visits, and know they have good access to that physician. “Parents should also be involved in monitoring the child for any signs of suicidal tendencies,” he says.

“Because Prozac was the first of the newer antidepressants, its effects on children have been studied the most,” says Harper. “Kids with serious depression, anxiety disorders, and obsessive-compulsive disorder can benefit from it.”

It’s not necessary to stay on the drugs forever, he notes. “Most antidepressants are recommended for 6 to 12 months, then backing off depending on how the patient is doing. Unfortunately, it takes weeks and weeks — up to 12 weeks — before we know if the drug is working.”

During the first several weeks of taking the drug, suicidal risk seems higher, says Harper. “It might be some people are so depressed they literally don’t have energy to act on their suicidal impulse. When they start taking the antidepressant, they are better able to act on it.”