Persisting Decline in Depression Treatment After FDA Warnings

Libby, Anne M.; Orton, Heather D.; Valuck, Robert J.

doi:10.1001/archgenpsychiatry.2009.46

Cited by 133 publications

(86 citation statements)

References 26 publications

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“…74 Most of the reductions in diagnosing and prescribing were related to substantial reductions by primary care providers, with these reductions persisting through 2007. 75 Studies differed as to whether there was 76 or was not 73,74 a compensatory increase of psychotherapy treatment during the same time period.…”

Section: Antidepressant Medications and Suicidementioning

confidence: 99%

Suicide and Suicide Attempts in Adolescents

Shain¹,

Braverman²,

Adelman³

et al. 2016

Pediatrics

298

147

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Suicide is the second leading cause of death for adolescents 15 to 19 years old. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist pediatricians, in collaboration with other child and adolescent health care professionals, in the identification and management of the adolescent at risk for suicide. Suicide risk can only be reduced, not eliminated, and risk factors provide no more than guidance. Nonetheless, care for suicidal adolescents may be improved with the pediatrician’s knowledge, skill, and comfort with the topic, as well as ready access to appropriate community resources and mental health professionals.

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Section: Antidepressant Medications and Suicidementioning

confidence: 99%

Suicide and Suicide Attempts in Adolescents

Shain¹,

Braverman²,

Adelman³

et al. 2016

Pediatrics

298

147

View full text Add to dashboard Cite

show abstract

“…Treatment guidelines recommend acute-and continuation-phase treatment (6-12 months) for children and adolescents with MDD, and maintenance treatment lasting ‡1 year may be recommended for patients with severe, recurrent, and chronic symptoms (Birmaher et al 2007; American Academy of Child and Adolescent Psychiatry 2009). Rates of antidepressant prescribing, however, have declined in the United States (Nemeroff et al 2007;Libby et al 2009) and the United Kingdom (Murray et al 2005), since a warning for suicidal ideation and behavior was added to antidepressant labeling based on a signal of increased risk for suicidal ideation and behavior in pediatric patients (Laughren 2006). In a retrospective insurance claims database analysis designed to assess cost of delaying pharmacotherapy in 7344 adolescents diagnosed with depression, a 1-12 month delay in the first prescription of a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) was associated with significantly higher medical costs and an increased risk of depression-related emergency department visits compared with patients who started pharmacotherapy within 1 month of diagnosis (Yu et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Safety and Tolerability of Desvenlafaxine in Children and Adolescents with Major Depressive Disorder

Findling

Groark

Chiles

et al. 2014

Journal of Child and Adolescent Psychopharmacology

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Objective: The purpose of this study was to assess long-term safety and tolerability of desvenlafaxine (administered as desvenlafaxine succinate) in children and adolescents with major depressive disorder (MDD). Methods: An 8 week, multicenter, open-label, fixed-dose study of children (ages 7-11 years) and adolescents (ages 12-17 years) with MDD was followed by a 6 month, flexible-dose extension study. Patients were administered desvenlafaxine 10-100 mg/day (children) or 25-200 mg/day (adolescents) for a total of 8 months. Treatment-emergent adverse events (AEs), withdrawals because of AEs, laboratory tests, vital signs, and the Columbia Suicide-Severity Rating Scale (C-SSRS) were collected. Eight month safety results from the lead-in plus extension studies are reported for extension study participants, using lead-in study day -1 as baseline. Results: Forty patients were enrolled in both studies (20 children; 20 adolescents). Of those, four children and three adolescents withdrew because of AEs. Treatment-emergent AEs reported by three or more patients were upper abdominal pain (15%) and headache (15%) in children, and somnolence (30%), nausea (20%), upper abdominal pain (15%), and headache (15%) in adolescents. Negativism (oppositional behavior) in a child was the single serious AE reported. No deaths occurred during the lead-in or extension studies. Mean pulse rates demonstrated statistically significant increases from lead-in study baseline to final evaluation (children, + 5.2 bpm; adolescents, + 5.9 bpm; p £ 0.05). No statistically significant change in blood pressure was observed at final evaluation. Two adolescents (0 children) reported suicidal ideation on the C-SSRS at screening assessment and during the lead-in and/or extension trials; one adolescent reported suicidal ideation after screening only. Conclusions: Long-term (8 month) treatment with desvenlafaxine was generally safe and well tolerated in depressed children and adolescents.

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“…Although generally well tolerated, SSRIs have been associated with an increased risk of behavioural activation and worsening of suicidal ideation in paediatric depression patients (Hammad et al 2006). Also, while the relationship of SSRIs to suicide remains controversial (Olfson et al 2003a ;Dubicka et al 2006 ;Gibbons et al 2006), regulatory warnings may have slowed the increasing trend for antidepressant prescription observed through the mid-2000s (Nemeroff et al 2007 ;Libby et al 2009). …”

Section: Introductionmentioning

confidence: 99%

Polypharmacy with antidepressants in children and adolescents

Díaz‐Caneja

Espliego

Parellada

et al. 2012

Int. J. Neuropsychopharm.

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The aim of this study was to review current epidemiological data on the use of antidepressants in co-prescription with other psychotropic drugs in children and adolescents, as well as available efficacy and safety information. A Medline search from inception until February 2012 was performed to identify epidemiological and clinical studies, reviews and reports containing potentially relevant information on polypharmacy with antidepressants in young people. There has been an increase in polypharmacy in children and adolescents involving antidepressants in recent years. Antidepressants have become one of the drug classes most frequently prescribed in combination and are commonly co-prescribed with stimulants and antipsychotics. Most information regarding efficacy and safety of polypharmacy patterns was provided by case series and open-label studies. Efficacy studies gave some support for the use of a combination of antidepressants and antipsychotics in the management of refractory obsessive-compulsive disorder and some residual symptoms in major depressive disorder. Even less empirical support was found for a combination of stimulants and antidepressants in co-morbid attention deficit hyperactivity disorder and mood or anxiety disorders. Adverse events were similar to those found with individual medication groups, with severe adverse events mostly reported by individual case reports. The use of polypharmacy with antidepressants has become a regular practice in clinical settings. Although there is still little efficacy and safety information, preliminary evidence points to the potential clinical usefulness of some polypharmacy patterns. Further research on patients with co-morbidities or more severe conditions is needed, in order to improve knowledge of this issue.

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Persisting Decline in Depression Treatment After FDA Warnings

Cited by 133 publications

References 26 publications

Suicide and Suicide Attempts in Adolescents

Suicide and Suicide Attempts in Adolescents

Safety and Tolerability of Desvenlafaxine in Children and Adolescents with Major Depressive Disorder

Polypharmacy with antidepressants in children and adolescents

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