Wednesday, August 5, 2009

Misleading Report Says Antidepressant Use Doubled

In a previous blogpost [7/20/09] we noted a “chilling effect” of FDA black box warnings on antidepressants that caused a sharp reduction in their prescribing. The fallout was an increase in suicides and escalating economic costs, as noted in a compelling evidence review [for details, see lengthy report].

Now comes an article in the August 2009 edition of the Archives of General Psychiatry observing how antidepressant use has doubled in the United States, and more than 10% of the population — 27 million Americans — took these medications in 2005 alone [Olfson and Marcus 2009]. Quite an impressive number, which news media quickly featured in dramatic headlines — completely missing the point that the data are outdated!

This just-published research compared household-reported data from 1996 with those from 2005. Only toward the end of their report do the authors acknowledge, “In October 2004, the U.S. Food and Drug Administration issued a ‘black box’ warning that antidepressants pose significant risks of suicide in children and adolescents.” They neglect to mention that the warning also was extended in 2007 to include young adults, and that prior to the warnings antidepressant prescribing had been expanded to include the treatment of certain pain conditions and other disorders, which accounted for increasing usage trends during 1996 to 2005.

In an understatement, the authors do concede that as a result of FDA actions, “[prescribing] trends may change in more recent years.” Indeed, trends have changed dramatically during the past few years (as we reported). So much so, that it makes this 1996-2005 comparison of little value for today, and quite misleading.

Caveats: It is not unusual for data-review studies to rely on information from several years prior, even though today’s situation may be entirely different. Government data are particularly notorious for lagging behind. News media rarely take this into account, and there are serious risks for practitioners and policy makers in not accurately distinguishing between historical data trends and current realities.

Reference: Olfson M, Marcus SC. National patterns of antidepressant medication treatment. Arch Gen Psychiatry. 2009;66(8):848-856.