Antidepressant Prescriptions: The Real Trend
6 CommentsBy Ed Silverman // September 18th, 2007 // 8:47 am
Two weeks ago, the controversy over antidepressants and Black Box warnings for suicides re-emerged after yet another study in the American Journal of Psychiatry suggested that prescriptions fells due to the publicity given the issue three years ago. Then, CDC data was released showing a rise in suicide among youngsters in 2004 - before the warnings actually showed up on labeling.
The American Psychiatric Association complains the warnings are scaring away docs and patients, some of whom may benefit from the meds. So what affect did those Black Box warnings have on antidepressant usage? We asked Medco, the big pharmacy benefits manager, to share annual scrip data and the trend is interesting…
Scrips for male and female youngsters between 10 and 19 years old were rising between 2001 and 2003, although the rate of growth was actually slowing. Then, 2004 was relatively flat. There was a dramatic drop in 2005, but prescriptions appeared to have leveled off again in 2006. Look at the chart and see for yourself.
As an example, 4.6 percent of female youngsters filled a scrip in 2003, and that fell 10.3 percent by 2006. Among boys, 3.8 percent filled a scrip in 2003, and that dropped to 3.2 percent in 2006. But again, the rate for both groups was virtually unchanged from 2005 to 2006. Data for the first half of 2007 isn’t yet available.
So what are the implications? A drop is a drop. But the hand-wringing by the APA may be overwrought. For the moment, the downturn in scrips has stopped. And there’s nothing to suggest scrips aren’t being written. Instead, what the data may indicate is that, perhaps, the publicity has served to remind some docs that antidepressant scrips shouldn’t be written wily-nily.
Ben Hansen
More ammunition for the “black box warning linked to increased suicides” debate…
See Table 29, “Studies assessing Suicidal thoughts and behavior” on page 106 of the Agency for Healthcare Research and Quality Final Research Review published January 2007,
“Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression.”
Twelve studies are cited. None show any difference between any of the SSRIs, and none show any advantage of SSRIs over older “first generation” antidepressants. Only 4 of the 12 studies compared antidepressants to placebo, and in all 4 of these studies, PLACEBOS OUTPERFORMED ANTIDEPRESSANTS. Summarized below.
Fergusson et al., 2005.
Meta-analysis: SSRIs vs. placebo.
Results: Higher risk of suicide attempts for SSRI-treated patients.
Gunnell et al., 2005.
Meta-analysis: Citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, all vs. placebo.
Results: Increased risk of nonfatal suicide attempts compared with placebo; no difference in risk among drugs.
Pedersen, 2005.
Retrospective cohort study: Escitalopram vs. placebo.
Results: Higher rate of nonfatal suicide attempts for escitalopram than for placebo.
Aursnes et al., 2005.
Meta-analysis of unpublished Paroxetine data.
Results: Higher rate of suicides for paroxetine than for placebo.
Read the AHRQ report here:
http://effectivehealthcare.ahrq.gov/reports/topic.cfm?topic=8&sid=39&rType=3&sType=2
http://effectivehealthcare.ahrq.gov/repFiles/Antidepressants_Final_Report.pdf
sea
Earning their pay, perhaps?
Lisa
It appears that Industry and their apologists,”SCREAMED FIRE” in a crowded room when there was none.Even worse… the media ran with the false claim of fire and its impending danger.
Children’ lives depend on the truth…All these individuals should be ashamed of themselves….
sid
Again I will say - the black box warning debate is dead. As we can see it has NO effect. So put it in there, make it a gold box or a yellow box - no change.
Lisa
Sid,
I would prefer neon orange box over black box anyday..
Sashaproduction@mac.com
I have a graduate degree in Psychology and want nothing to do with the field because of their whorish behavior with the AMA concerning psychotropics.
MD’s have little to no psychological training and prescribe antidepressants during routine office visits (office visit +$150), psychiatrists spend less than 15 minutes talking to the patients they treat with meds (office visit +$150) and counselors with four years of mental health education that spend an hour talking with the patient (office visit +25)? Talk therapy has proven its importance time and again for a wide range of disorders, while medications have only proven themselves worthy for manic depressives, bi-polars and schizophrenics. By worthy, I mean worth the risk of the side effects (of which are still not fully known).
Please, don’t let your friends become victims of this fraud, talk to them!!! The number of prescriptions for antidepressants is surpassing the number 1 and 2 prescribed cholesterol and heartburn pills.
Doesn’t this scare you?