Drop in adolescent antidepressant use after FDA warnings resulted in negative effects

Charlie Plain | August 1, 2014

A new study from the School of Public Health at the University of Minnesota in collaboration with researchers at Dartmouth College and Yale University concludes that 2003-2004 U.S. Food and Drug Administration (FDA) warnings that reduced antidepressant treatment among adolescents with depression problems had negative effects on grade point average, substance use and delinquent behaviors.

The findings were published today in the Journal of Human Resources.

Depression and other mental health problems will affect 15 percent of U.S. children by the time they reach 18. Depression in adolescents is associated with poor academic outcomes, along with higher rates of substance abuse and delinquent behaviors. These consequences of depression during adolescence may help explain why depression is associated with lower rates of employment and earnings among adults.

“Most evidence on depression treatment focuses on depression symptoms, but not the broader consequences of depression for academic performance and behavioral outcomes like substance use or delinquency,” said Ezra Golberstein, Ph.D., an author of the study and assistant professor of health policy and management in the University of Minnesota School of Public Health.

To understand the broader effects of treating adolescents with antidepressants, the authors analyzed the reported grades, substance use and delinquency of over 100,000 adolescents in national surveys conducted before and after FDA warnings regarding suicidality and antidepressant use in children led to sudden steep declines in antidepressant use.

Following the FDA warnings, treatments like psychotherapy remained relatively similar to previous levels, rather than offsetting declines in pharmaceutical treatment; in other words, after FDA warnings total treatment of depression fell. Many children and adolescents with depression problems now receive no treatment. This study suggests that efforts to improve access to mental health care for these youth may yield large social benefits that go well beyond the clinical outcomes captured in most assessments of treatment benefits.

“We found adolescents who sought treatment for depression after the FDA warnings had poorer grades, more use of tobacco and illicit drugs, and more delinquency after a clinic visit, compared to adolescents seeking treatment for depression prior to the warnings,” said Ellen Meara, Ph.D., an author of the study and associate professor of health policy and clinical practice at the Geisel School of Medicine at Dartmouth.

The effects were more pronounced in adolescent girls than boys. The researchers were not able to definitively explain why the FDA warnings seemed to affect adolescent girls differently than boys.

Other key findings:

  • Grade point averages for adolescent girls with depression problems fell by 0.2 points after the FDA warnings, equivalent to a drop from B to B- for an average student.
  • Rates of smoking, illicit drug use and inappropriate use of prescription drugs increased in girls after FDA warnings. For example, rates of illicit drug use rose by more than five percentage points among adolescent girls with depression problems after the FDA warnings.
  • Rates of fighting and stealing among girls increased after FDA warnings.

The authors caution that their study, which was funded by the National Institute on Drug Abuse, “does not favor one form of depression treatment over another.” Instead, Golberstein notes the findings, “tell us that treating adolescents who have depression problems can help mitigate the effects of a disease that has lifelong consequences.”

~ Post by Matt DePoint, Academic Health Center

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