Services and prevention: Pharmacoepidemiology of antidepressant use

Between 1988 and 1994, data from 3 large sites revealed a 3-5 fold increase in the prevalence of antidepressant (ATD) treatment for U,S. youths aged 2 -19 years. In 1994, the ATD prevalence for youths of this age ranged from 1 3 per 1000 (in the HMO) to 18 per 1000 (in 2 state Medicaid systems). Males predominated in the 10-14-year-olds treated with ATDs, whereas females pre dominated among 15-19-year-olds. Caucasians were more than twice as likely to receive ATD therapy than their African-American counterparts. Primary ca re providers were the major soul ce of ATD prescriptions for youths. The le nding diagnoses in primary care were ADHD followed by depression, whereas t he diagnostic order was reversed for youths who received psychiatric servic es. This review provides details concerning these patterns and trends in AT D treatment of youths from community-based clinical data sources. In additi on, the role of these data in art expanded, comprehensive psychotropic know ledge base is discussed Finally, the implications of an expanded knowledge base for ATD treatments are discussed in regard to generating research ques tions on effectiveness and safety and to improve treatment consensus within a public-health perspective. (C) 2001 Society of Biological Psychiatry.