Effects of the Committee on Safety of Medicines Advice on Antidepressant Prescribing to Children and Adolescents in the UK
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Background: Psychotropic medication prescribing for children and adolescents rose significantly between 2000 and 2002, including antidepressant prescribing. In 2003, the Committee on Safety of Medicines (CSM) advised against using venlafaxine or any selective serotonin receptor inhibitor (SSRI), with the exception of fluoxetine, for childhood and adolescent depression. The aim of this study was to compare the prevalence and incidence of children and adolescents who were prescribed antidepressants in UK primary care, before and after the CSM advice on antidepressant prescribing. We also compared paediatric antidepressant prescribing trends from Mediplus data with national antidepressant prescribing trends in England from the Prescription Pricing Authority (PPA).
Methods: The Disease Analyzer-Mediplus database contains anonymised primary care records for about 3 million patients. Eligible patients were aged ≤18 years and received ≥1 antidepressant prescription between 2000 and 2004. Antidepressants were grouped according to the CSM advice and the British National Formulary. Prevalence and incidence were calculated. The prevalences of 2000, 2002 and 2004 were compared using a Chi-squared test. PPA data on antidepressant prescribing rates were compared with paediatric antidepressant prescribing rates from Mediplus.
Results: 5718 children and adolescents received a total of 25 542 prescriptions between 2000 and 2004. The median number of prescriptions per patient was two (interquartile range 1–5). Common indications included depression and anxiety. Antidepressant prevalence increased from 2000 to 2002 (from 5.4 to 6.6 patients per 1000 people), with a rise in the number of patients prescribed venlafaxine and SSRIs. However, between 2002 and 2004 there was a decrease in antidepressant prevalence (from 6.6 to 5.7 per 1000). The prevalence of CSM-contraindicated antidepressants (citalopram, escitalopram, fluvoxamine, paroxetine, sertraline and venlafaxine) declined by a third (from 3.1 to 2.0 per 1000), but there was no change in fluoxetine prevalence (from 2.1 to 2.3 per 1000). The number of patients prescribed tricyclic antidepressants dropped marginally (from 2.0 to 1.7 per 1000). Incidences followed the same trends as the prevalences, but there was a 48% reduction in the incidence of CSM-contraindicated antidepressants between 2002 and 2004. National antidepressant prescribing trends increased; paediatric prescribing trends were similar to national trends between 2000 and 2003; however, there was a 27% reduction in the paediatric prescribing rate of CSM-contraindicated antidepressants between 2002 and 2004.
Conclusion: Since 2003, fewer children and adolescents have been prescribed antidepressants in primary care. However, fluoxetine and non-SSRI antidepressant prevalences have not risen, implying that they are not prescribed as alternative treatments. This study shows that the CSM advice has had a significant effect in reversing the rising prevalence of antidepressant prescribing to children and adolescents in primary care.
- Wong ICK, Murray ML, Camilleri-Novak D, et al. Increased prescribing trends of paediatric psychotropic medications. Arch Dis Child 2004; 89: 1131–2 CrossRef
- Murray ML, de Vries CS, Wong ICK. A drug utilisation study of antidepressants in children and adolescents using the General Practice Research Database. Arch Dis Child 2004; 89: 1098–102 CrossRef
- Committee on Safety of Medicines. Selective serotonin reuptake inhibitors (SSRIs): overview of regulatory status and CSM advice relating to major depressive disorder (MDD) in children and adolescents including a summary of available safety and efficacy data 2003. Available from URL: http://www.medicines.mhra.gov.uk/ourwork/monitorsafequalmed/safetymessages/ssrioverview_101203.htm [Accessed 2005 Apr 5]
- Wong ICK, Besag FMC, Santosh PJ, et al. Use of selective serotonin reuptake inhibitors in children and adolescents. Drug Saf 2004; 27(13): 991–1000 CrossRef
- The Research Unit on Pediatric Psychopharmacology Anxiety Study Group. Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 2001; 344: 1279–85
- Geller DA, Biederman J, Stewart SE, et al. Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder. Am J Psychiatry 2003; 160: 1919–28 CrossRef
- Wong IC, Murray ML. Potential of clinical databases for paediatric medication research in the UK. Br J Clin Pharmacol 2005; 59(6): 750–5 CrossRef
- Lawrenson RA, Coles G, Walton K, et al. Characteristics of practices contributing to the Mediplus database and the implications for its use in epidemiological research. J Inform Prim Care 1998 May, 18
- Langman M, Kahler KH, Kong SX, et al. Drug switching patterns among patients taking non-steroidal anti-inflammatory drugs: a retrospective cohort study of a general practitioners database in the United Kingdom. Pharmacoepidemiol Drug Saf 2001; 10(6): 517–24 CrossRef
- British Medical Association, Royal Pharmaceutical Society of Great Britain. British National Formulary (September). London: Pharmaceutical Press, 2004: 194–205
- Prescription statistics publications. Prescriptions dispensed in the community in England. Available from URL: http://www.publications.doh.gov.uk/prescriptionstatistics/index.htm [Accessed 2005 Jun 13]
- National Statistics. Population estimates: current releases. Available from URL: http://www.statistics.gov.uk/statbase/explorer.asp?.CTG = 3 & S L = 4819&D = 4819&DCT = 0&DT = 32#4819 [Accessed 2005 Jun 23]
- Committee on Safety of Medicines. Report of the CSM Expert Working Group on the Safety of Selective Serotonin Reuptake Inhibitor Antidepressants: Annex A — Prescribing trends for SSRIs and related antidepressants 2004. Available from URL: http://www.medicines.mhra.gov.uk/ourwork/monitorsafequalmed/safetymessages/Annex%20A.pdf [Accessed 2005 Feb 1]
- Wong ICK, Novak-Camilleri D, Stephens P. Rise in psychotropic drug prescribing in children in the UK: an urgent public health issue. Drug Saf 2003; 26(15): 1117–8 CrossRef
- Kennedy E. Child and adolescent psychotherapy: a systematic review of psychoanalytic approaches. London: North Central London Strategic Health Authority, 2004
- Effects of the Committee on Safety of Medicines Advice on Antidepressant Prescribing to Children and Adolescents in the UK
Volume 28, Issue 12 , pp 1151-1157
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- 1. The School of Pharmacy, Centre for Paediatric Pharmacy Research, University of London and the Institute of Child Health, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
- 2. IMS Health, Disease Analyzer Centre of Excellence, Pinner, London, UK
- 3. Department of Child & Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK