The number of children and adolescents who are prescribed newer antidepressants known as SSRIs has decreased substantially in the U.S. since the release of public health advisories linking these drugs with a raised risk of suicide in young patients, investigators report.

The Food and Drug Administration (FDA) issued advisories in October 2003 and March 2004 after receiving data that suggested an increased risk of suicidal behavior among young people given SSRIs. In October 2004, the FDA mandated that manufacturers include black-box warnings with the information on all antidepressants.

The question of whether these warnings have affected doctors’ prescribing practices has not been firmly established, Dr. Amir Kalali, from Quintiles Transnational in Research Triangle Park, North Carolina, and colleagues point out in the Archives of General Psychiatry.

To provide a more comprehensive analysis, Kalali’s group reviewed retail pharmacy data for nearly half of all annual prescriptions in the U.S. and prescription audit data from 3400 office-based physicians.

Between April 2002 and February 2004, the number of antidepressant prescriptions rose by 0.79 percent per month among patients younger than age 18. After February 2004, the rate decreased by 4.23 percent per month, the team reports.

They also found that SSRIs represented 74.5 percent of all antidepressants prescribed for patients younger than 18 years up to February 2004, but this declined to 57.9 percent one year later.

Physician associations, including the American Medical Association and the American Academy of Child and Adolescent Psychiatry, have expressed concern that the FDA’s advisories “may limit access to necessary, appropriate, and effective treatment for children and adolescents with depression, anxiety, and other psychiatric disorders.”

They also suggest that the risk of SSRIs has been overblown and the drugs’ benefits may be overlooked. As Kalali’s group points out, compared with SSRIs, older antidepressants agents have a worse side effect profile and can be lethal in overdose.

SOURCE: Archives of General Psychiatry, April 2007.