Two studies were recently published that pretty clearly indicate that since the U.S. Food and Drug Administration (FDA) issued an advisory about antidepressant medications being prescribed to children in March 2004, prescriptions of antidepressants to children declined. We reported on the negative effect of prescribing behavior to depressed children earlier this month. Another study was released in June 2007 in the American Journal of Psychiatry that showed similar results.
In reviewing the American Journal of Psychiatry study (Libby et. al. 2007), I noticed two items of interest. One is that the study found that pediatricians and primary care physicians accounted for the largest reductions in new diagnoses of depression in children. Isn’t that interesting? A government agency releases a warning about one specific type of treatment for a disorder and suddenly family doctors stop seeing as much of this disorder in their patients.
This is a wonderful data point indicating that as much as some doctors protest that they practice evidence-based medicine, their human instincts and biases are always present. There’s no logical reason (and nothing in the research) to suggest that there should be any decline in diagnoses of a disorder because of concerns about one possible treatment for that disorder. That’s just a basic human fear response — “Geez, the treatment I’m used to providing for depression has just gotten an advisory notice. I better be a lot more cautious in diagnosing this disorder now.”
Unfortunately, that caution likely costs lives in underdiagnosis.
The other interesting note is that, given that antidepressants in children were now deemed “suspect” by the FDA (which many docs overgeneralized to mean, “refrain from prescribing these as much as possible”), you’d think that docs would present patients with the myriad of other effective treatment options for depression. You know, like psychotherapy?
If you thought that, you’d be wrong:
Among patients with depression, the proportion receiving no antidepressant increased to three times the rate predicted by the preadvisory trend, and SSRI prescription fills were 58% lower than predicted by the trend. There was no evidence of a significant increase in use of treatment alternatives (psychotherapy, atypical antipsychotics, and anxiolytics).
That’s just as disturbing as the lower diagnosis of depression in children. Are primary care physicians really that ignorant of the wide variety of non-antidepressant treatments available for childhood depression?
Another strong argument for referring anyone with a mental health issue to an experienced mental health professional, such as a psychiatrist, psychologist, or psychotherapist. I’d suggest most primary care physicians really need to remove themselves from treating mental health problems — most simply don’t have the experience and expertise to do so in a way that most benefits their patients.
Reference: Libby AM, Brent DA, Morrato EH, Orton HD, Allen R, Valuck RJ. (2007). Decline in treatment of pediatric depression after FDA advisory on risk of suicidality with SSRIs. Am J Psychiatry, 164(6):843-6.