Impact of regulatory safety warnings on the use of antidepressants among children and adolescents in Finland
Foulon, Veerle × Svala, A Koskinen, L Chen, T Saastamoinen, L Bell, S #
International Journal of Psychiatry in Clinical Practice vol:13 pages:30-30
IFMAD edition:9 location:Monaco date:11-13 November 2009
Background and objectives
Antidepressant medications are widely prescribed to children and adolescents, despite limited published data supporting their safety and efficacy in this population. From October 2003 onwards, FDA and other agencies have issued safety warnings drawing attention to suicidal ideation / behavior among children and adolescents taking SSRI’s. A series of previous studies have revealed significant reductions in the use of antidepressants among children and adolescents following these advisories in Australia, Canada, Ireland, Norway, The Netherlands, United Kingdom and United States. The objective of this study was to analyze and describe changes in the prevalence and incidence of antidepressant use among children and adolescents in Finland post October 2003.
The sample comprised all children and adolescents in Finland aged ≤ 19.0 years (n=27,676) who collected one or more reimbursed prescriptions for an antidepressant in non-institutional and non-hospital settings between January 1998 and December 2005. Time series models were used to compare antidepressant use 60 months before and 24 months after the health advisory issued by the FDA in October 2003.
The annual prevalence of antidepressant use increased from 2.23 users/1000 youths in 1998 to 5.93 users/1000 youths in 2005. The annual incidence of antidepressant use increased from 2.01 new users/1000 youths in 1999 to 3.12 new users/1000 youths in 2005. There was a significant increase in the monthly incidence of SSRI use (+0.02498), fluoxetine use (+0.00691) and sertraline use (+0.00727) post October 2003. When considering pre-advisory trends in antidepressant utilization, only the incidence of fluoxetine use was higher than the predicted post October 2003 incidence (p<0.001). Use of all other SSRIs was significantly lower than predicted.
In contrast to m other countries, the overall use of antidepressants and SSRI’s continued to increase among children and adolescents in Finland post October 2003. While the rate of fluoxetine use increased, the rate of all other SSRI use decreased and/or was lower than predicted.