November 25, 2005

Child Antidepressant Use Increases

By Amy Norton

NEW YORK -- The number of U.S. children and teens who were diagnosed with depression more than doubled between 1995 and 2002, while the use of antidepressant drugs rose and the use of psychotherapy or counseling declined.

The findings, say researchers, 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.

In addition, although only one antidepressant, Prozac (fluoxetine), has been specifically approved for patients younger than 18, prescriptions for other antidepressants rose after 1995 as well -- 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," the study authors report in the Journal of Adolescent Health.

It's not clear why antidepressant use increased during the study period, according to lead study author Dr. Jun Ma of the Stanford University School of Medicine, Palo Alto, California.

But, she told Reuters Health, it likely reflects 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 antidepressants will continue to supplant counseling for children and teens is in question. Last year, U.S. health officials 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 linked to certain antidepressants.

Ma said it will be important to track how this change affects prescribing trends. She noted, however, that the warning label is not intended to "scare" doctors and patients away from antidepressants, because the drugs can be an important part of treating children with major depression.

The study is based on U.S. government health statistics collected yearly between 1995 and 2002, the most recent year for which data were available.

Ma's team found that among children ages 7 to 17, the number of doctor visits for depression more than doubled -- from 1.44 million in 1995-1996 to 3.22 million in 2001-2002.

At the same time, treatment with psychotherapy or counseling declined, with 68 percent of children receiving this form of therapy by 2002, compared with 83 percent between 1995 and 1998. In contrast, the proportion of visits in which antidepressants were prescribed rose to 52 percent by 2002 compared with 47 percent between 1995 and 1998.

Prozac was the most commonly prescribed antidepressant, but Zoloft (sertraline) and Paxil (paroxetine) were close behind.

The fact that counseling declined as antidepressant use rose suggests that for many children, drugs were used instead of, rather than as a complement to, counseling, according to Ma and her colleagues.

Current evidence, they point out, indicates that Prozac, used along with talk therapy, should be the first-choice antidepressant for children, and only if that fails should other drugs be considered.

This study, the researchers conclude, "raises concerns about physicians' adherence to evidence-based medicine."

SOURCE: Journal of Adolescent Health, December 2005.