Abstract
BackgroundDetailed research on long-term antidepressant (AD) trends within a single large US Medicaid population of youth has not heretofore been reported.MethodsAdministrative claims data for eight annual timepoints across 28 years (1987–2014) were organized for youth (<20 years old) who were continuously enrolled during each study year in a mid-Atlantic state Medicaid program. Total annual AD prevalence and age-, gender-, race-, eligibility group-, and diagnosis-specific prevalence were formed from bivariate analyses; logistic regression assessed the change in use (2007–2014) adjusted for covariates. AD-polypharmacy data were assessed in 2014.ResultsThe major findings are: 1) AD use in state Medicaid enrollees grew 14-fold between 1987 and 2014. Data from 2014 revealed significantly increased odds of youth with SSRI/SNRI dispensings compared to 2007 (AOR=1.15 95% CI 1.11–1.19), representing 78% of total AD users. 2) Recent AD increases were greatest for 15–19-year olds. 3) AD use in girls passed up AD use in boys for the first time in 2014. 4) In 2014, ADs for foster care (12.7%) were 6 times greater than for their income-eligible Medicaid-counterparts. 5) In 2014, a quarter of AD-medicated youth were diagnosed with a behavior disorder. 6) More than 40 percent of AD medicated youth had >=1 other concomitant psychotropic classes for 60 or more days.ConclusionsSecond-generation antidepressant use in Medicaid-insured youth has increased despite growing questions that pediatric AD benefits may not outweigh harms. These patterns support the call for publicly funded, independent investigator-conducted post-marketing outcomes research.
Highlights
Since the introduction of second-generation antidepressants in 1988, there has been a steady increase in their use to treat major depressive disorder and other mental health conditions in the pediatric population
Questions persist regarding AD efficacy [4], the 2004 FDA boxed warning and safety concerns for suicidality [5], new questions about long-term use with the risk of weight gain and metabolic disorders [6] and prominent concerns about difficulty to discontinue ADs in long-term users due to a withdrawal syndrome [7]. Added to these concerns is the fact that pediatric AD use is largely off-label, that is without adequate evidence that benefits outweigh risks either because of age or the diagnosis and indication selected by the treating physician [8]
Lee et al showed that in a national study of youths 6 to 18 years of age in outpatient care settings from 2000 to 2006, antidepressants for an FDA-approved indication applied in only 9.2% of visits, the remainder being for off-label uses [9]
Summary
Since the introduction of second-generation antidepressants (selective serotonin and selective norepinephrine reuptake inhibitors [SSRI and SNRI]) in 1988, there has been a steady increase in their use to treat major depressive disorder and other mental health conditions in the pediatric population. Questions persist regarding AD efficacy [4], the 2004 FDA boxed warning and safety concerns for suicidality [5], new questions about long-term use with the risk of weight gain and metabolic disorders [6] and prominent concerns about difficulty to discontinue ADs in long-term users due to a withdrawal syndrome [7] Added to these concerns is the fact that pediatric AD use is largely off-label, that is without adequate evidence that benefits outweigh risks either because of age or the diagnosis and indication selected by the treating physician [8]. Detailed research on long-term antidepressant (AD) trends within a single large US Medicaid population of youth has not heretofore been reported
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