- The Washington Times - Tuesday, August 8, 2006

TRENTON, N.J. (AP) — A large study has found that patients on antidepressants rarely get the psychiatric therapy needed right after they start the drugs, a time when risk of suicidal behavior can rise temporarily.

Two-thirds of children and even more adults did not see a doctor or therapist for mental health care once within a month of beginning drug treatment, said the study by Medco Health Solutions Inc., which manages prescription benefits for health plans.

Specialists suggest the cost of therapy, a lack of follow-up by busy family doctors and a shortage of psychiatrists in some parts of the country might help explain the problem.

Medco’s study of 79,488 adults and 5,026 youngsters reviewed prescription and doctor-visit records from July 2001 through September 2003. That was before the government urged drug makers to put warnings on their products calling for close monitoring of suicidal thoughts or violent behavior in the early weeks after starting the drugs.

“Many of these people probably should have had more follow-up than they did, regardless of the FDA guidelines,” said Dr. Glen Stettin of Franklin Lakes, N.J.-based Medco.

In early 2004, the Food and Drug Administration (FDA) recommended that new antidepressant users see a doctor once a week for the first month and three more times in the subsequent two months.

That advice is the agency’s “best estimate” of what is reasonable, said Dr. Thomas Laughren, director of the Division of Psychiatry Products at the FDA.

Dr. Laughren said he is concerned that so few people in the study failed to get therapy, but said the sicker patients probably received more help.

The Medco study also looked at treatment through the first three months and found that more than half of the children and three-quarters of adults still had not had a mental health visit. Fewer than 15 percent of patients got all the treatment the FDA recommends in the first month, said the study, which was published in this month’s American Journal of Managed Care.

More than half of antidepressant prescriptions are written by family doctors; only about 40,000 psychiatrists are practicing nationwide.

That is one reason some think that patients receive little follow-up care. In addition, Dr. Darrel Regier, the American Psychiatric Association’s director of research, said that carrying out the FDA treatment recommendations would push up costs up more than 50 percent.

Dr. Stettin and other physicians said follow-up therapy probably has improved since Medco’s study was conducted because of heavy press attention, particularly about antidepressants and suicide concerns with teenagers. Medco plans an update to see if that has occurred.

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