Antidepressant Use By Young People After FDA Warnings
Antidepressant Use By Young People After FDA Warnings
The study cohorts included approximately 1.1 million adolescents, 1.4 million young adults, and 5 million adults per quarter; the key characteristics were stable over time ( Table 1 ). Figures 1 to 3 present the 2000-10 time series of antidepressant dispensings and psychotropic drug poisonings with segmented regression results by age group. Estimated changes in levels and trends of time series from segmented regression models are available in the Supplementary File ( Table B ). For ease of interpretation, we also present absolute and relative changes to represent the full effect of the widely publicized warnings in the second year after the warnings. Changes in dispensings of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are available in the Supplementary File ( Table C ).
(Enlarge Image)
Figure 1.
Rates of antidepressant use, psychotropic drug poisonings, and completed suicides per quarter before and after the warnings among adolescents enrolled in 11 health plans in nationwide Mental Health Research Network
(Enlarge Image)
Figure 2.
Rates of antidepressant use, psychotropic drug poisonings, and completed suicides per quarter before and after the warnings among young adults enrolled in 11 health plans in nationwide Mental Health Research Network
(Enlarge Image)
Figure 3.
Rates of antidepressant use, psychotropic drug poisonings, and completed suicides per quarter before and after the warnings among adults enrolled in 11 health plans in nationwide Mental Health Research Network
Adolescents
After the warnings, there was an abrupt decline in the previously upward trend of antidepressant use by adolescents (Fig 1). We estimated a relative reduction of 31.0% in antidepressant use in the second year after the warnings (95% confidence interval -33.0% to -29.0%; Table 2 ); the absolute change was -0.70 percentage points (95% confidence interval -0.76 to -0.63). At the same time as the substantial reduction in antidepressant use, we observed a sharp increase in psychotropic drug poisonings (Fig 1). We estimated a significant relative increase of 21.7% in psychotropic drug poisonings in the second year after the warnings (95% confidence interval 4.9 to 38.5); the absolute change was 0.002 percentage points (0.0007 to 0.0033). Increases in psychotropic drug poisonings were statistically significant among males ( Table 2 ). Our sensitivity analysis also detected a significant relative increase of 13.9% (10.0% to 17.8%) in poisonings by any drugs among adolescents in the second year after the warnings.
Completed suicides were rare. Figure 1 presents three point moving averages of quarterly suicide rates over time, adjusting for seasonal trends. We did not observe changes in completed suicides among adolescents; suicide rates ranged from 0.31 to 0.82 per 100 000 people per quarter before the warnings, and from 0.28 to 0.68 per 100 000 people per quarter after the warnings.
After the warnings, there was an immediate reversal of the upward trend of antidepressant use in young adults (Fig 2). We observed a relative reduction of 24.3% in antidepressant use in the second year after the warnings (-25.4% to -23.2%; Table 2 ); the absolute change was -1.22 percentage points (-1.29 to -1.14). Simultaneously, there was a noticeable increase in psychotropic drug poisonings (Fig 2), with a relative increase of 33.7% in the second year after the warnings (26.9% to 40.4%) and an absolute change of 0.004 percentage points (0.0033 to 0.0047). Increases in psychotropic drug poisonings were significant among both sexes ( Table 2 ). We observed consistent increases in psychotropic drug poisonings in study sites located in different regions across the country when we combined adolescent and young adult groups (data not shown owing to research ethics and privacy regulations; absolute changes ranged from 0.001 to 0.019 percentage points). Our sensitivity analysis did not detect changes in poisonings by any drugs after the warnings among young adults.
Completed suicide rates appeared to be stable, ranging from 1.25 to 1.76 per 100 000 people per quarter before the warnings, and from 1.33 to 1.85 per 100 000 people per quarter after the warnings (Fig 2). We did not observe discontinuities in completed suicides when we combined the data from adolescents and young adults.
Adults
After the warnings, antidepressant use decreased suddenly among adults (Fig 3). In the second year after the warnings there was a relative reduction of 14.5% in antidepressant use (-16.0% to -12.9%; Table 2 ); the absolute change was -1.62 percentage points (-1.83 to -1.41). There was a statistically insignificant increase in the trend of psychotropic drug poisonings after the warnings (Fig 3); we estimated a relative increase of 5.2% in the second year after the warnings (-6.5 to 16.9) and an absolute increase of 0.0005 percentage points (-0.0006 to 0.0016). Our sensitivity analysis did not find changes in poisonings by any drugs after the warnings among adults. There was no change in completed suicides (Fig 3), ranging from 1.76 to 2.06 per 100 000 people per quarter before the warnings, and from 1.86 to 2.27 per 100 000 people per quarter after the warnings.
Results
The study cohorts included approximately 1.1 million adolescents, 1.4 million young adults, and 5 million adults per quarter; the key characteristics were stable over time ( Table 1 ). Figures 1 to 3 present the 2000-10 time series of antidepressant dispensings and psychotropic drug poisonings with segmented regression results by age group. Estimated changes in levels and trends of time series from segmented regression models are available in the Supplementary File ( Table B ). For ease of interpretation, we also present absolute and relative changes to represent the full effect of the widely publicized warnings in the second year after the warnings. Changes in dispensings of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are available in the Supplementary File ( Table C ).
(Enlarge Image)
Figure 1.
Rates of antidepressant use, psychotropic drug poisonings, and completed suicides per quarter before and after the warnings among adolescents enrolled in 11 health plans in nationwide Mental Health Research Network
(Enlarge Image)
Figure 2.
Rates of antidepressant use, psychotropic drug poisonings, and completed suicides per quarter before and after the warnings among young adults enrolled in 11 health plans in nationwide Mental Health Research Network
(Enlarge Image)
Figure 3.
Rates of antidepressant use, psychotropic drug poisonings, and completed suicides per quarter before and after the warnings among adults enrolled in 11 health plans in nationwide Mental Health Research Network
Effects of the Warnings
Adolescents
After the warnings, there was an abrupt decline in the previously upward trend of antidepressant use by adolescents (Fig 1). We estimated a relative reduction of 31.0% in antidepressant use in the second year after the warnings (95% confidence interval -33.0% to -29.0%; Table 2 ); the absolute change was -0.70 percentage points (95% confidence interval -0.76 to -0.63). At the same time as the substantial reduction in antidepressant use, we observed a sharp increase in psychotropic drug poisonings (Fig 1). We estimated a significant relative increase of 21.7% in psychotropic drug poisonings in the second year after the warnings (95% confidence interval 4.9 to 38.5); the absolute change was 0.002 percentage points (0.0007 to 0.0033). Increases in psychotropic drug poisonings were statistically significant among males ( Table 2 ). Our sensitivity analysis also detected a significant relative increase of 13.9% (10.0% to 17.8%) in poisonings by any drugs among adolescents in the second year after the warnings.
Completed suicides were rare. Figure 1 presents three point moving averages of quarterly suicide rates over time, adjusting for seasonal trends. We did not observe changes in completed suicides among adolescents; suicide rates ranged from 0.31 to 0.82 per 100 000 people per quarter before the warnings, and from 0.28 to 0.68 per 100 000 people per quarter after the warnings.
Young Adults
After the warnings, there was an immediate reversal of the upward trend of antidepressant use in young adults (Fig 2). We observed a relative reduction of 24.3% in antidepressant use in the second year after the warnings (-25.4% to -23.2%; Table 2 ); the absolute change was -1.22 percentage points (-1.29 to -1.14). Simultaneously, there was a noticeable increase in psychotropic drug poisonings (Fig 2), with a relative increase of 33.7% in the second year after the warnings (26.9% to 40.4%) and an absolute change of 0.004 percentage points (0.0033 to 0.0047). Increases in psychotropic drug poisonings were significant among both sexes ( Table 2 ). We observed consistent increases in psychotropic drug poisonings in study sites located in different regions across the country when we combined adolescent and young adult groups (data not shown owing to research ethics and privacy regulations; absolute changes ranged from 0.001 to 0.019 percentage points). Our sensitivity analysis did not detect changes in poisonings by any drugs after the warnings among young adults.
Completed suicide rates appeared to be stable, ranging from 1.25 to 1.76 per 100 000 people per quarter before the warnings, and from 1.33 to 1.85 per 100 000 people per quarter after the warnings (Fig 2). We did not observe discontinuities in completed suicides when we combined the data from adolescents and young adults.
Adults
After the warnings, antidepressant use decreased suddenly among adults (Fig 3). In the second year after the warnings there was a relative reduction of 14.5% in antidepressant use (-16.0% to -12.9%; Table 2 ); the absolute change was -1.62 percentage points (-1.83 to -1.41). There was a statistically insignificant increase in the trend of psychotropic drug poisonings after the warnings (Fig 3); we estimated a relative increase of 5.2% in the second year after the warnings (-6.5 to 16.9) and an absolute increase of 0.0005 percentage points (-0.0006 to 0.0016). Our sensitivity analysis did not find changes in poisonings by any drugs after the warnings among adults. There was no change in completed suicides (Fig 3), ranging from 1.76 to 2.06 per 100 000 people per quarter before the warnings, and from 1.86 to 2.27 per 100 000 people per quarter after the warnings.
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