Antidepressant use by preschoolers rising

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Preschoolers are leading the growth in use of antidepressants by U.S. children, even though many questions persist about the safety and effectiveness of using these drugs on minors.

A study published in the journal Psychiatric Services found that children 5 years old and younger are the fastest-growing segment of the nonadult population using antidepressants today,

The study examined antidepressant use from 1998 to 2002 among 2 million youngsters ages 18 and younger who were covered by commercial health insurance. About one in 15 children in the United States is covered by commercial insurance, according to officials of Express Scripts Inc. of St. Louis, which conducted the study.

The research found that use of antidepressants continues to grow by about 10 percent annually among American children and teens.

But among preschoolers, the study found that use among girls doubled from eight per 10,000 to 16 per 10,000 during the four-year study period. Among preschool boys, antidepressant use rose by 64 percent, from 14 per 10,000 to 23 per 10,000.

Express Scripts is one of the largest pharmacy benefit-management companies in North America. It provides services to 50 million members. Its clients include managed care organizations, insurance carriers, third-party administrators, employers and union-sponsored-benefit plans.

Tom Delate, director of research for Express Scripts and lead author of the study, declined to provide specific numbers of children taking antidepressants in various age groups. But one table in his report suggests that nearly 30,000 children 18 and under were taking antidepressants in 1998; and that the total was 45,000 in 2002.

Prevalence of use is far greater among older children. The study found that in 2002, nearly 6.4 percent of U.S. girls ages 15 to 18 years -- or 640 per 10,000 -- were taking antidepressants.

Among boys that age, 4.2 percent -- or 420 per 10,000 -- were on such drugs, the study showed.

The new study was based on pharmacy-claims information from a random national survey of children and teens. "We're pretty confident" it is accurate, Mr. Delate said yesterday in a telephone interview.

Mr. Delate cited factors he believes may have led to an "escalated use of antidepressants among children and adolescents." They include rising rates of depression among the young; a growing awareness of and screening for depression by pediatricians; and assumptions -- not necessarily valid -- that available treatments should be as effective in youths as they are in adults.

Specifically, the study showed that the prevalence of antidepressant use among all children 18 and younger increased from 160 per 10,000 in 1998 (1.6 percent) to 240 per 10,000 in 2002 (2.4 percent). That was an adjusted annual increase of 9.2 percent.

"We demonstrated an increase in use of antidepressants by children without evidence supporting efficacy and safety" in the young, Mr. Delate said.

The authors of the report concluded that use of antidepressant medications among minors is continuing to grow and that it is "driven primarily by greater use" of a category of drugs known as selective serotonin reuptake inhibitors, or SSRI.

SSRIs, the most popular antidepressants with American adults, include medicines such as paroxetine (Paxil); fluoxetine (Prozac), or Zoloft.

According to the report, the "growth in the overall prevalence of antidepressant use was greater among girls (a 68 percent increase) than among boys (a 34 percent increase)." The Express Scripts' study found that the use of paroxetine rose 113 percent in girls and 90 percent in boys during the four-year research period.

Several months ago, an advisory panel to the U.S. Food and Drug Administration (FDA) held a hearing in which the effectiveness of SSRIs in treating depression in children was challenged. The FDA charged that they increased the risk of suicidal thoughts and suicide attempts among teenagers.

Recently, the FDA, Health Canada, and the United Kingdom's Medicines and Healthcare Products Regulatory Authority recommended that paroxetine not be used by younger children and adolescents, because of uncertainty about its efficacy and the potential risk of suicide.

Among SSRIs, only fluoxetine, or Prozac, has been approved by the FDA for treating depression in children and teens.