Trends in prescriptions for antidepressant pharmacotherapy among US children and adolescents diagnosed with depression, 1990 through 2001: An assessment of accordance with treatment recommendations from the American Academy of Child and Adolescent Psychiatry

Abstract

Background: In 1998, the American Academy of Child and Adolescent Psychiatry (AACAP) published a position paper supporting the use of selective serotonin reuptake inhibitors (SSRIs) as first-line pharma-cotherapy for the treatment of depression among children and adolescents. Tricyclic antidepressants (TCAs) were not recommended because of insufficient efficacy evidence, as well as adverse events. Objective: The present study was designed to discern the prescribing patterns for antidepressants among US children and adolescents aged 5 to 18 years diagnosed with depression between 1990 and 2001 (ie, before and after the publication of the AACAP paper). Methods: Data derived from the US National Ambulatory Medical Care Survey for the years 1990 through 2001 were used for this retrospective, cross-sectional analysis examining children and adolescents aged 5 to 18 years. Information from physician-patient encounters (office-based visits), documenting a diagnosis of depression ( International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] codes 296.2–296.36, 300.4, or 311) were extracted. Data were categorized into three 4-year time intervals: 1990 through 1993; 1994 through 1997; and 1998 through 2001. Results: Overall, the rate of antidepressant prescriptions for US patients who received a diagnosis of depression increased from 44.4% (1,138,689/2,561,890) in the period from 1990 through 1993 to 59.3% (4,103,683/6,923,040) in the period from 1998 through 2001. SSRI prescriptions increased from 20.7% (530,642/2,561,890) in the period from 1990 through 1993 to 39.7% (2,745,293/6,923,040) in the period from 1998 through 2001; TCA prescriptions decreased from 21.0% (537,906/2,561,890) in the period from 1990 through 1993 to 2.7% (188,823/6,923,040) in the period from 1998 through 2001. The US population-adjusted rate of a diagnosis of depression with or without comorbid mental illness ( ICD-9-CM codes 290–296.19, 296.4–300.39, 300.5–310.99, or 312.0–319) increased 2.4-fold from 12.9 per 1000 in the period from 1990 through 1993 to 31.1 in the period from 1998 through 2001. Among these patients, the prescribing of an antidepressant increased 3.2-fold (5.7 per 1000 in the period from 1990 through 1993 to 18.4 in the period from 1998 through 2001). The population-adjusted rate of SSRI prescribing increased 4.6-fold from 2.7 per 1000 children and adolescents in the period from 1990 through 1993 to 12.3 in the period from 1998 through 2001. Conclusions: From 1990 through 2001, prescription patterns for antidepressant pharmacotherapy among children and adolescents aged 5 to 18 years changed. In accordance with the recommendation made by the AACAP in 1998, prescriptions for SSRIs increased, whereas prescriptions for TCAs all but disappeared.