he number of teenagers and children being
prescribed antidepressants in the United States dropped 18 percent
over the last year after studies found that the medicines appeared
to lead some to become suicidal, according to one provider of drug
In a study done at the behest of The New
York Times, Medco Health Solutions found that 43,859 of the
roughly 3.5 million children and teenagers for whom the company
provided drug benefits in July, or 1.26 percent, were prescribed
antidepressants that month. That is down from 60,902 children and
teenagers, or 1.69 percent of the total, who were prescribed the
drugs a year earlier. It was the first decline in prescriptions for
antidepressants among teenagers and children in years, the company
Some experts greeted the news with guarded optimism, saying that
it meant that physicians may be using more care when prescribing the
drugs to youngsters.
"You would hope that the inappropriate use of these medicines has
dried up a bit," said Dr. Richard Malone, a pediatrician in
Baltimore and a member of the Food and Drug Administration's
advisory committee that concluded last week that the agency should
place a strong warning on the drugs about the risk of suicidal
thoughts or behavior in pediatric patients.
The finding by Medco Health Solutions is at odds with information
provided last week by the F.D.A. to its advisory committee. An
F.D.A. official told the committee that prescriptions of
antidepressants for children and teenagers continued to rise by 7
percent this year despite a growing controversy about the safety of
the drugs. "We did not see any decline," Michael Evans, a drug use
specialist with the F.D.A.'s office of drug safety, told the
Mr. Evans told the committee that his information came from IMS
Health, a health information and consulting company. Lance
Longwell, a spokesman for IMS Health, said that the company provided
data to the agency, but that the agency did its own analysis.
IMS Health obtained most of its information about drug use by
surveying pharmacies, but it did not collect patient information.
Mr. Longwell said that he did not know how the agency distinguished
between prescriptions given to adults and those given to teenagers
and children. A spokesman for the F.D.A. said the agency would not
Medco provides prescription drug benefits for about 60 million
Americans over the course of a year, or about a fourth of those who
have health insurance in the United States. The company's finding on
antidepressants resulted from a direct analysis of its patients'
prescription drug histories, said Ann Smith, a Medco spokeswoman.
The Medco data suggest that the controversy about the safety of
antidepressants has made an impression on physicians, young patients
and their parents. Last summer, GlaxoSmithKline,
the manufacturer of Paxil, and Wyeth,
the maker of Effexor, both warned that studies of their drugs in
youngsters indicated that some had become suicidal. For
GlaxoSmithKline, the warning came from an analysis requested by the
F.D.A. that looked at studies that the company had kept largely
secret. None of the children in the trials committed suicide, but
some thought about or attempted suicide, researchers found.
After these findings, the F.D.A. asked manufacturers of seven
other antidepressants to study the effects of their drugs on
children and teenagers. Taken together, the studies found that
children and teenagers given antidepressants are twice as likely to
become suicidal as those given placebos. In February, the F.D.A.'s
advisory committee suggested that the agency provide a general
warning about the risks of suicide among antidepressants users,
which the agency did in March.
Last week, the advisory committee voted that the drugs' warnings
should be strengthened. The agency is still studying the committee's
recommendation and promised to act within months.
Dr. Lauren Marangell, an associate professor of psychiatry at
Baylor College of Medicine in Houston and another member of the
advisory committee, said at last week's hearing that despite the
growing evidence of the risks of the drugs she was not hoping for a
decline in antidepressant use among the young.
"I don't want to see prescriptions drop because these people need
to be treated," Dr. Marangell said at the hearing. "They need to be
warned about the risks."
In an interview yesterday, Dr. Marangell said it was impossible
to tell whether the decline found by Medco was real and, if so,
whether it was beneficial.
"It's bad news if kids that need treatment don't get it, and it's
good news if people who don't need the drugs aren't getting them,"
Dr. Marangell said. Others said that the Medco data were consistent
with their experience.
Dr. Malone, the Baltimore pediatrician, said he received two
telephone calls from parents of patients he had put on
antidepressants asking if it was time to end the therapy.
"I have 3,500 children in my practice, and to get two calls on
the same issue on the same day is pretty unusual," he said.
Both parents said that they were concerned about the newfound
risks of the drugs, Dr. Malone said.
James McGough, a professor of clinical psychiatry at the
University of California, Los Angeles, and another member of the
advisory committee, said that antidepressants were often given to
the wrong young patients for the wrong reasons. On the other hand,
he said he saw a depressed young girl yesterday who needed
antidepressant therapy. "But her parent is so afraid of the
medicines that it's getting in the way of what this girl truly