Advertisement

European Child & Adolescent Psychiatry

, Volume 23, Issue 12, pp 1211–1218 | Cite as

Use of SSRIs among Danish children: a nationwide study

  • Anton Pottegård
  • Helga Zoëga
  • Jesper Hallas
  • Per Damkier
Original Contribution

Abstract

Our objective was to describe the use of selective serotonin reuptake inhibitors (SSRIs) in the entire Danish population of children and adolescents from 1995 to 2011. Data on filled SSRIs were obtained for all children in Denmark aged 5–17 during 1995–2011. The amount and type of SSRIs filled were calculated as well as incidence rates and prevalence proportions. Furthermore, we looked at concurrent use of other psychotropic drug treatment duration. A total of 23,547 children aged 5–17 used SSRIs during the study period, most commonly sertraline followed by citalopram. Overall, the incidence rate increased from 0.57 per 1,000 person years in 1997 to 3.30 in 2010 and fell to 2.55 in 2011, while the prevalence proportion rose from 0.1 per 1,000 children at the end of 1995 to 3.3 at the end of 2011. However, these findings were driven entirely by an increase among adolescents (12–17 years), where the prevalence proportion rose from 0.11 and 0.36 to 4.64 and 8.52 per 1,000 boys and girls, respectively. A significant proportion of SSRI users used other psychotropic drugs concurrently, most notably antipsychotics (12–28 %) and psychostimulants (10–33 %). About 50 % of adolescents and 40 % of children discontinued treatment within 12 months of initiation. We found a marked increase in the use of SSRI drugs among adolescents in Denmark between 1995 and 2011. Whether this increase reflects a true increase in disorder occurrence, an increase in diagnostic intensity or more aggressive treatment remains uncertain.

Keywords

SSRIs Antidepressants Drug utilization study Children Adolescents 

Notes

Conflict of interest

JH has participated in research projects funded by Pfizer with grants paid to the institution where he was employed. He has personally received fees for consultation from the Danish Association of Pharmaceutical Manufacturers and from Lundbeck. PD is a paid consultant for Fertin Pharma, Denmark. AP and HZ report no conflicts of interest.

References

  1. 1.
    Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Erkens JA et al (2007) Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry 164:1356–1363PubMedCrossRefGoogle Scholar
  2. 2.
    Vitiello B, Swedo S (2004) Antidepressant medications in children. N Engl J Med 350:1489–1491PubMedCrossRefGoogle Scholar
  3. 3.
    The Danish Ministry of Health and Prevention. (Guide to medicamental treatment of children and adolescents with psychiatric disorders, VEJ no 10332); Cited 11 Dec 2012. Available from www.retsinformation.dk/
  4. 4.
    European Medicines Agency (EMA). European Medicines Agency finalizes review of antidepressants in children and adolescents. EMEA/CHMP/128918/2005; Cited 11 Dec 2012. Available from: www.ema.europa.eu
  5. 5.
    Summary of Product Characteristics.; Cited 11 Dec 2012. Available from: www.produktresume.dk
  6. 6.
    Danish Medicines Agency. (Drugs against depression for children and adolescents); Cited 11/12/2012. Available from: www.laegemiddelstyrelsen.dk
  7. 7.
    Frank L (2000) Epidemiology. When an entire country is a cohort. Science 287:2398–2399PubMedCrossRefGoogle Scholar
  8. 8.
    Kildemoes HW, Sorensen HT, Hallas J (2011) The Danish national prescription registry. Scand J Public Health 39:38–41PubMedCrossRefGoogle Scholar
  9. 9.
    Thygesen LC, Ersboll AK (2011) Danish population-based registers for public health and health-related welfare research: introduction to the supplement. Scand J Public Health 39:8–10PubMedCrossRefGoogle Scholar
  10. 10.
    National Institute for Health Data and Disease Control. Medstat.dk; Cited 4 April 2013. Available from: www.medstat.dk/en
  11. 11.
    WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2013. 2012 OsloGoogle Scholar
  12. 12.
    European Medicines Agency (EMA). ICH Topic E 11: Clinical Investigation of Medicinal Products in the Paediatric Population. Note for guidance on clinical investigation of medicinal products in the paediatric population (CPMP/ICH/2711/99). 2001Google Scholar
  13. 13.
    Nissen JB, Thomsen PH (2008) Clinicians’ views on clinical examination and treatment of children and adolescents with obsessive-compulsive disorder (OCD). A Danish national survey study. Nord J Psychiatry 62:309–314PubMedCrossRefGoogle Scholar
  14. 14.
    Bhatia SK, Rezac AJ, Vitiello B, Sitorius MA, Buehler BA, Kratochvil CJ (2008) Antidepressant prescribing practices for the treatment of children and adolescents. J Child Adolesc Psychopharmacol 18:70–80PubMedCrossRefGoogle Scholar
  15. 15.
    Katz LY, Kozyrskyj AL, Prior HJ, Enns MW, Cox BJ, Sareen J (2008) Effect of regulatory warnings on antidepressant prescription rates, use of health services and outcomes among children, adolescents and young adults. CMAJ 178:1005–1011PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Pamer CA, Hammad TA, Wu YT, Kaplan S, Rochester G, Governale L et al (2010) Changes in US antidepressant and antipsychotic prescription patterns during a period of FDA actions. Pharmacoepidemiol Drug Saf 19:158–174PubMedCrossRefGoogle Scholar
  17. 17.
    Valluri S, Zito JM, Safer DJ, Zuckerman IH, Mullins CD, Korelitz JJ (2010) Impact of the 2004 food and drug administration pediatric suicidality warning on antidepressant and psychotherapy treatment for new-onset depression. Med Care 48:947–954PubMedCrossRefGoogle Scholar
  18. 18.
    Murray ML, de Vries CS, Wong IC (2004) A drug utilisation study of antidepressants in children and adolescents using the general practice research database. Arch Dis Child 89:1098–1102PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Wijlaars LP, Nazareth I, Petersen I (2012) Trends in depression and antidepressant prescribing in children and adolescents: a cohort study in The Health Improvement Network (THIN). PLoS One 7:e33181PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Zoega H, Baldursson G, Hrafnkelsson B, Almarsdottir AB, Valdimarsdottir U, Halldorsson M (2009) Psychotropic drug use among Icelandic children: a nationwide population-based study. J Child Adolesc Psychopharmacol 19:757–764PubMedCrossRefGoogle Scholar
  21. 21.
    Saastamoinen LK, Wallin M, Lavikainen P, Airaksinen MS, Sourander A, Bell JS (2012) Treatment duration with selective serotonin reuptake inhibitors among children and adolescents in Finland: a nationwide register study. Eur J Clin Pharmacol 68:1109–1117PubMedCrossRefGoogle Scholar
  22. 22.
    Steffenak AK, Wilde-Larsson B, Nordstrom G, Skurtveit S, Hartz I (2012) Increase in psychotropic drug use between 2006 and 2010 among adolescents in Norway: a nationwide prescription database study. Clin Epidemiol 4:225–231PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Fegert JM, Kolch M, Zito JM, Glaeske G, Janhsen K (2006) Antidepressant use in children and adolescents in Germany. J Child Adolesc Psychopharmacol 16:197–206PubMedCrossRefGoogle Scholar
  24. 24.
    Koelch M, Prestel A, Singer H, Keller F, Fegert JM, Schlack R et al (2009) Psychotropic medication in children and adolescents in Germany: prevalence, indications, and psychopathological patterns. J Child Adolesc Psychopharmacol 19:765–770PubMedCrossRefGoogle Scholar
  25. 25.
    Sevilla-Dedieu C, Kovess-Masfety V (2008) Psychotropic medication use in children and adolescents: a study from France. J Child Adolesc Psychopharmacol 18:281–289PubMedCrossRefGoogle Scholar
  26. 26.
    Merikangas KR, He JP, Rapoport J, Vitiello B, Olfson M (2013) Medication use in US youth with mental disorders. JAMA Pediatr 167:141–148PubMedCrossRefGoogle Scholar
  27. 27.
    Vitiello B, Zuvekas SH, Norquist GS (2006) National estimates of antidepressant medication use among US children, 1997–2002. J Am Acad Child Adolesc Psychiatry 45:271–279PubMedCrossRefGoogle Scholar
  28. 28.
    Zito JM, Tobi H, de Jong-van den Berg LT, Fegert JM, Safer DJ, Janhsen K et al (2006) Antidepressant prevalence for youths: a multi-national comparison. Pharmacoepidemiol Drug Saf 15:793–798PubMedCrossRefGoogle Scholar
  29. 29.
    The Danish BupBase. (The Danish Database for Child and Adolescent Psychiatry 2005–2010 Annual Reports); Cited 5 March 2013. Available from: www.bupnet.dk
  30. 30.
    The Danish Health and Medicines Authority. (Development in Child and Adolescent Psychiatry Activity 2007–2010); Cited 12 March 2013. Available from: www.sst.dk
  31. 31.
    Lee E, Teschemaker AR, Johann-Liang R, Bazemore G, Yoon M, Shim KS et al (2012) Off-label prescribing patterns of antidepressants in children and adolescents. Pharmacoepidemiol Drug Saf 21:137–144PubMedCrossRefGoogle Scholar
  32. 32.
    Pottegard A, Bjerregaard BK, Glintborg D, Kortegaard LS, Hallas J, Moreno SI (2013) The use of medication against attention deficit/hyperactivity disorder in Denmark: a drug use study from a patient perspective. Eur J Clin Pharmacol 69:589–598PubMedCrossRefGoogle Scholar
  33. 33.
    Pottegard A, Bjerregaard BK, Glintborg D, Hallas J, Moreno SI (2012) The use of medication against attention deficit hyperactivity disorder in Denmark: a drug use study from a national perspective. Eur J Clin Pharmacol 68:1443–1450PubMedCrossRefGoogle Scholar
  34. 34.
    Diaz-Caneja CM, Espliego A, Parellada M, Arango C, Moreno C (2012) Polypharmacy with antidepressants in children and adolescents. Int J Neuropsychopharmacol 1–20 [Epub ahead of print]Google Scholar
  35. 35.
    Comer JS, Olfson M, Mojtabai R (2010) National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996–2007. J Am Acad Child Adolesc Psychiatry 49:1001–1010PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Dean AJ, McDermott BM, Marshall RT (2006) Psychotropic medication utilization in a child and adolescent mental health service. J Child Adolesc Psychopharmacol 16:273–285PubMedCrossRefGoogle Scholar
  37. 37.
    McIntyre RS, Jerrell JM (2009) Polypharmacy in children and adolescents treated for major depressive disorder: a claims database study. J Clin Psychiatry 70:240–246PubMedCrossRefGoogle Scholar
  38. 38.
    Schirm E, Tobi H, Zito JM, de Jong-van den Berg LT (2001) Psychotropic medication in children: a study from the Netherlands. Pediatrics 108:E25PubMedCrossRefGoogle Scholar
  39. 39.
    Geller B, Tillman R, Bolhofner K, Zimerman B (2010) Pharmacological and non-drug treatment of child bipolar I disorder during prospective eight-year follow-up. Bipolar Disord 12:164–171PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M (2007) National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry 64:1032–1039PubMedCrossRefGoogle Scholar
  41. 41.
    Duffy FF, Narrow WE, Rae DS, West JC, Zarin DA, Rubio-Stipec M et al (2005) Concomitant pharmacotherapy among youths treated in routine psychiatric practice. J Child Adolesc Psychopharmacol 15:12–25PubMedCrossRefGoogle Scholar
  42. 42.
    Hunkeler EM, Fireman B, Lee J, Diamond R, Hamilton J, He CX et al (2005) Trends in use of antidepressants, lithium, and anticonvulsants in Kaiser Permanente-insured youths, 1994–2003. J Child Adolesc Psychopharmacol 15:26–37PubMedCrossRefGoogle Scholar
  43. 43.
    Daviss WB (2008) A review of co-morbid depression in pediatric ADHD: etiology, phenomenology, and treatment. J Child Adolesc Psychopharmacol 18:565–571PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Esbjorn BH, Hoeyer M, Dyrborg J, Leth I, Kendall PC (2010) Prevalence and co-morbidity among anxiety disorders in a national cohort of psychiatrically referred children and adolescents. J Anxiety Disord 24:866–872PubMedCrossRefGoogle Scholar
  45. 45.
    Kunwar A, Dewan M, Faraone SV (2007) Treating common psychiatric disorders associated with attention-deficit/hyperactivity disorder. Expert Opin Pharmacother 8:555–562PubMedCrossRefGoogle Scholar
  46. 46.
    Masi G, Perugi G, Toni C, Millepiedi S, Mucci M, Bertini N et al (2006) Attention-deficit hyperactivity disorder: bipolar comorbidity in children and adolescents. Bipolar Disord 8:373–381PubMedCrossRefGoogle Scholar
  47. 47.
    Fontanella CA, Bridge JA, Marcus SC, Campo JV (2011) Factors associated with antidepressant adherence for Medicaid-enrolled children and adolescents. Ann Pharmacother 45:898–909PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Anton Pottegård
    • 1
    • 2
  • Helga Zoëga
    • 3
    • 4
  • Jesper Hallas
    • 1
    • 2
  • Per Damkier
    • 1
    • 2
  1. 1.Clinical Pharmacology, Institute of Public HealthUniversity of Southern DenmarkOdense CDenmark
  2. 2.Department of Clinical Chemistry and PharmacologyOdense University HospitalOdense CDenmark
  3. 3.Centre of Public Health Sciences, Faculty of MedicineUniversity of IcelandReykjavíkIceland
  4. 4.Institute for Translational EpidemiologyIcahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations