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Impact of Publicity Concerning Pediatric Suicidality Data on Physician Practice Patterns in the United States
Charles B. Nemeroff, MD, PhD;
Amir Kalali, MD;
Martin B. Keller, MD;
Dennis S. Charney, MD;
Susan E. Lenderts, BA;
Elisa F. Cascade, MBA;
Hugo Stephenson, MD;
Alan F. Schatzberg, MD
Arch Gen Psychiatry. 2007;64(4):466-472.
Context IMS Health Inc data presented by the Food and Drug Administration (FDA) on September 13 and 14, 2004, at a joint meeting of the Center for Drug Evaluation and Research's Psychopharmacologic Drugs Advisory Committee and the FDA's Pediatric Advisory Committee suggested that the number of children and teenagers who were prescribed antidepressants continued to increase in 2004, despite widespread publicity surrounding 2 FDA advisories regarding the potential for pediatric suicidality with selective serotonin reuptake inhibitor use. These results are contradictory to findings from the Medco Health Solutions, Inc, March 2004 analysis of pharmacy benefit claims and a separate subsequent analysis conducted by NDC Health using dispensing data from March 31, 2004, through June 30, 2005.
Objectives To investigate the contradictory findings and provide additional analyses on the prescribing trends of antidepressants across age groups and physician specialties in the United States.
Design Retail pharmacy prescription data and physician audit data were obtained from Verispan, a joint venture between Quintiles Transnational and McKesson. In addition to examining prescribing trends, a joinpoint regression analysis was conducted to identify the timing for significant changes in prescription use.
Results The analyses suggest that the number of children and teenagers who were prescribed antidepressants has decreased significantly (P = .02) in the wake of widespread publicity surrounding the FDA public health advisories. Another impact of the advisories seems to be a shift in care from "generalists" to psychiatric specialists when it comes to prescribing antidepressants to patients younger than 18 years. Finally, the analyses highlight a slight shift in prescribing toward the non–selective serotonin reuptake inhibitor bupropion hydrochloride, even though it carries the same FDA "black box" warning as the selective serotonin reuptake inhibitors.
Conclusions The effect on antidepressant prescribing volume observed in our analysis of the Verispan data parallels earlier findings reported by Medco Health Solutions, Inc, and NDC Health that the FDA actions have had a significant effect on the prescribing of antidepressants to children and adolescents. Together, these findings underline the importance of presenting a fair balance within the media due to the significant reach of this channel among prescribing physicians.
Author Affiliations: Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Ga (Dr Nemeroff), and Stanford University School of Medicine, Stanford, Calif (Dr Schatzberg); Quintiles Transnational, Research Triangle Park, NC (Drs Kalali and Stephenson and Mss Lenderts and Cascade); Department of Psychiatry and Human Behavior, Brown University, Providence, RI (Dr Keller); and Department of Psychiatry, Mt Sinai School of Medicine, New York, NY (Dr Charney).
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