Antidepressant Prescriptions Drop For Teens
26 CommentsBy Ed Silverman // September 26th, 2007 // 12:25 pm
This will cause a ruckus. Verispan is reporting that total scrips for antidepressants for teenagers age 13 to 17 decreased nearly 18 percent between July 2003 and July 2007. And scrips for patients taking a drug for the first time fell 95 percent among all teenagers during the same 4-year period. (Go here).
The data shows that antidepressant scrips for teenagers have been declining for the past 4 years. In contrast, antidepressant scrips for patients 18 and older have grown approximately 13 percent during the same time period. [UPDATE: Verispan provided year-to-year data: As of July 2004, there were 5.8 million scrips written for teens 13 to 17 years old. That fell to 5.3 million the next year and 4.8 million in July 2006, before hitting 4.7 million this past July. Similarly, scrips fell to 2.3 million from 3.1 million during the same period for kids younger than 12.]
The American Psychiatric Association says the publicity in 2004 over the controversy linking the pills to suicide scared off many psychiatrists and patients from meds that may offer help to the depressed. They also blame the Black Box warnings the FDA required drugmakers to put on product labeling, although those didn’t appear until early 2005. The APA’s American Journal of Psychiatry recently published two studies arguing that point. It’s worth noting that the most recent study was funded, in part, by Pfizer and authored by researchers with financial ties to drugmakers that sell antidepressants.
In one respect, the Verispan data matches a trend seen in data from Medco, the pharmacy benefits manager, which found that….
…scrips for male and female youngsters between 10 and 19 years old were rising between 2001 and 2003, but the rate of growth was actually slowing. Then, 2004 was relatively flat. There was a dramatic drop in 2005, but scrips leveled off in 2006. Verispan’s data shows a 9 percent drop among teens from July 2004 to July 2005 and another 10 percent from July 2005 to July 2006. But from July 2006 to July 2007, scrips fell only 2 percent, suggesting the trend has finally slowed. As Express Scripts noted earlier this year in its annual Drug Trend report, “the decline prompted by suicidality warnings has subsided, and historical utilization growth should return.”
Meanwhile, Verispan is also reporting that visits by teenagers to physicians for depression fell 23 percent over the past 4 years. Visits by teenage males dropped by 28 percent, compared with a 23 percent declined among females. The percentage of teenage visits to docs for depression where a drug was issued dropped significantly - from 85 percent in the 12 months ending July 2004 to 69 percent in the 12 months ending July 2007.
Atlex
It should be noted that many of those who believe that the decline in use of antidepressants among teens is having a negative impact don’t lay blame on the black box, but instead believe that the controversy and media hoopla that culminated in the black box warning caused the drop in prescribing. That is why it starts a year or two prior to the black box.
Also of note, Versipan provides a much more comprehensive view of prescribing than does Medco.. Verispan’s approach focuses on the entire rretail market, whle Medco only focuses on scripts associated with its customers.
Reality
What Atlex said. It’s not the Black Box warning itself, but the warning signals that preceded it in 2003, after which prescribing fell quite precipitously.
Of course, there’s the potential post-hoc fallacy — just because result B followed action A, doesn’t mean A caused B. So whether the decreasing prescriptions caused the increased rate, who knows.
Also, of all of the recent antidepressant articles in the recent months, to me the most interesting (and least talked about) is the one from July by Simon and Savarino (http://ajp.psychiatryonline.org/cgi/content/full/164/7/1029), which showed that suicides were most likely to occur in the week before starting antidepressants, and declined thereafter. Granted, this doesn’t separate out the pediatric/adolescent population, but it’s interesting nonetheless.
Ed Silverman
Hi Guys,
I believe I got that one correct - as Atlex indicated the hoopla that led up to the Black Box warnings has been cited as a reason for the drop in scrips. Although the Black Box warnings also get blamed for the sustained decrease.
In any event, thank you both for writing in and pointing this out.
Regards
ed at Pharmalot
JM
Did Verispan or anyone else look into what percent of the under 18 population aged into the over 18 population during this time, and how many of those continued to fill antidepressant scripts? I would be curious to know if, and the extent to which there may be a “generation” of high utilizers, given the correlation between the decrease in children and increase in the adult population.
Lisa
Here we go again…..another abstract…”NO DATA”
Show us the raw data!!!
One can only assume Pfizer didnt enjoy Ed’s reporting on Medco’s data
JM
Amen Lisa.
Reality
Lisa,
What “no data” are you talking about? The link I posted?
Lisa
Hi Reality
I am having a wonderful day in our Nation’s Medicine Chest..
Hope you are having a nice day also!!…
I have seen the “Simon Study”just more junk science…Submit that to the FDA for approval and see how far you get….Let me know how you make out!….
Reality
Lisa,
You must be enjoying some medicine chest, because you’re barely making sense.
Please explain to me what makes the Simon study junk science. And no, mere conflict of interest does not equal junk. And why would I submit it to the FDA? For what purpose? It’s an epidemiological study on the relation of suicide timing to antidepressant prescriptions.
And what would you personally do with a raw dataset? Are you an expert in SAS? Are you going to perform your own statistical analysis?
You know, I realize you don’t trust pharma, the FDA, the CDC, Medco, Verispan, the AJP, the APA, the DSM IV, and god knows who else, but we’ve now seen similar data from 4 separate entities. At some point, you can’t just automatically write off everything because it doesn’t jibe with your worldview.
There’s a saying, “if the only tool you have is a hammer, everything looks like a nail.”
Lisa
Reality,
I believe you’ve answered your own questions. So there is no reason for me to chime in..
“Trust” or “Distrust” You have no idea..So, Please, in the future speak for yourself…..
And as I said earlier,It is a beautiful day in our Nation’s Medicine chest..A natural high,”Per Se”.
It doesnt take a “rocket scientist” to understand raw data!!!
“Hell”,even a “Sales Rep” Can understand it…..
Reality
Why is it that whenever I ask an actual question regarding science, I’m treated with meaningless non sequiturs, cliches, and basically, meaningless drivel?
I’ll ask again — it’s a very simple question: how is the Simon study junk science?
Lisa
Reality,
Industry themselves, will tell you,” IF IT IS NOT PLACEBO CONTROLLED, ITS JUNK SCIENCE.”
This is one area where Industry and I agree…..
Bob
Lisa, you say “only a sales rep can understand.”
WHat experience do you have in pharma, other than lawsuits?
Reality
That’s not an answer. I’m asking for YOUR opinion on why this is junk science.
Incidentally, Pharma doesn’t say that that non-placebo-controlled trials are junk science. It’s true that they are not as scientifically rigorous as prosepective, placebo-controlled trials, but that doesn’t make them junk. Sometimes a case-control study or the like is the only way you can measure something.
Calling something junk doesn’t make it so.
Lisa
Reality,
Its been a long day, and im tired…If you dont mind, and can wait til morning,ill provide you with a more accurate quote.
Thanks
Lisa
Bob,
Nice try…
Bob
Lisa,
I thought so.
Reality
Lisa,
I don’t want a more accurate quote from pharma that you’ll look up. That’s not what I asked for.
I want your opinion on what makes this particular study junk science. It’s an astonishingly simple request.
But yes, it’s late. I’ll look forward to your own personal, scientifically reasoned answer tomorrow.
Lisa
Reality,
Good Morrning, The Simon Study should have seperated children from adults,because children are not small adults!!
Again,only an abstract is provided.Why wasnt the study published in its entirety.
Case-controlled study=Ones Perception.
I have provided to you two Healthcare Provider letters Re: two antidepressants,as a Parent and Consumer these letters hold more weight than the Simon Study does.
As a Parent,I want the facts.I dont want, or need ones percepton of a particular(Non Placebo-controlled) study…
I hope I’ve answered your question
Reality
Lisa,
I’m well aware that kids are not just little adults. I noted that not separating out the pediatric population was a weakness of the study, although they did separate out
Lisa
The current trend in suicides for children and adolescents could be the result of the meteoric rise in pediatric prescriptions of atypical antipsychotics,such as Zyprexa and Risperdal.
According to research conducted by Medco Health Solutions,Inc., in which the company reviewed prescription drug claims of some 370,000 youngsters ages 10 to 19, the prevelance of adolescent girls taking antipsychotics has grown 117 percent in the past five years while it has increased 71 percent for boys. The suicide rates are even higher in patients taking antipsychotics than those on antidepressants.
Donna
Geeez, If only they had to “TRY IT” before they “APRROVE IT” and ” PRESCRIBE IT ” this would be so much easier……
Reality
I just realized my response above didn’t go through in full. Here it is:
Lisa,
I’m well aware that kids are not just little adults. I noted that not separating out the pediatric population was a weakness of the study, although they did separate out
Reality
Apparently the system doesn’t like the less-than symbol…let’s try it a 3rd time.
Lisa,
I’m well aware that kids are not just little adults. I noted that not separating out the pediatric population was a weakness of the study, although they did separate out those younger than 25 years. That doesn’t make this a bad study, per se. It should actually be a fairly easy proposition for the authors to run the analysis by age group.
The full study is available for subscribers or those who want to pay for it. Or you can go to a library and get it for free (minus the cost of the copy machine). They’re not hiding anything, they just don’t give away their publications for free.
Case-control is not one’s perception. It’s a comparison of events between 2 groups of people. Is the Framingham Heart Study junk science because it wasn’t a placebo-controlled study?
In the case of the Simon study, which wasn’t case-control (I only mentioned that earlier as an example of a non-placebo-controlled study), it was an analysis of pharmacy and outpatient claims from over 100,000 individuals — that’s a pretty robust sample.
Here’s the bottom line. I admire what you’re doing in theory — a lot of people have been harmed by drugs, bad docs, etc. The problem is–and I’m going to say this as gently as I can, and as non-pejoratively as I can — you don’t know what you don’t know. You assert authority regarding things you don’t fully understand. Not only does that diminish your credibility, but that ignorance misleads other people, breeding yet more ignorance.
I don’t claim to be an expert in anything, but I know when I’ve reached my level of understanding. And if I make a mistake or misspeak, I acknowledge it and correct it, I don’t bang the drum harder.
Lisa
Reality,
“Not seperating out the Pediatric population was a weakness of the study” Your words, not mine.
One can consider a weak study,”Junk Science”.
Reality
I didn’t say it was a weak study, but rather, that not separating out the peds population was weakness of the study.
Just because they didn’t do it to your exact expert specifications doesn’t make it junk science.