After five years of steady growth, diagnoses of depression in patients of all ages dropped like a rock in 2004, the year after the Food and Drug Administration warned that the current generation of antidepressant medications increased the risk of suicide and suicidal thinking in children.
By 2007, according to a study published today in the Archives of General Psychiatry, depression diagnoses had begun creeping back up. But physicians were still less inclined than they had been before the FDA's warning to diagnose a patient of any age with depression and to offer medication.
The new wariness was particularly pronounced among primary care physicians -- the doctors to whom most patients with mental health problems tend to turn first, wrote the authors. And the reluctance to diagnose and treat depression affected populations not even covered by the warnings that the FDA issued on selective serotonin reuptake inhibitors (SSRIs) in October 2003. During the three subsequent years, primary-care physicians diagnosed depression in adults 29% less often than would have been expected and 37% less often in young adults (a population that in May 2007 was included in the FDA's warning about SSRIs and increased suicidal thinking). The drop in depression diagnoses was sharpest for children -- 44%.
The study is the latest to suggest that the FDA's warning -- and the media coverage surrounding the issue of SSRIs and suicide -- have set back progress in treating depression, a condition that the mental health profession believes is seriously underdiagnosed.
While fewer prescriptions were written, patients who did get a diagnosis of depression were slightly more likely to receive at least one psychotherapy visit over the next six months. But the authors said that, overall, the use of psychotherapy as an alternative to medications appeared lower than would have been expected if doctors were routinely proposing talk therapy as a substitute for antidepressants.
Anne M. Libby and a team of researchers at the University of Colorado Denver's School of Medicine called the trends the "unintended consequences" of the FDA's first "black box" warning -- the agency's strongest safety alert to patients using a drug. The effect has been substantial, persistent and spread over a broad population of patients. If the trend of "reduced depression treatment" is to be reversed, Libby added, "policy actions are required."
For more patient information on the signs and consequences of and the range of treatments for depression, go here.
-- Melissa Healy