BRIEF REPORT Antidepressants in children and adolescents—changes in utilisation after safety warnings y Angela J. Dean PhD 1,2 * , Anna Hendy BPharm 3,4 and Treasure McGuire PhD 3,4 1 Kids in Mind Research, Mater Child & Youth Mental Health Service, Brisbane, Australia 2 Department of Psychiatry, School of Medicine, University of Queensland, Australia 3 Mater Pharmacy Services, South Brisbane, Australia 4 School of Pharmacy, University of Queensland, Australia SUMMARY Background Antidepressants, in particular selective serotonin reuptake inhibitors, are one of the most commonly used classes of psychotropic drug in children and adolescents. Beginning in June 2003, evidence emerged suggesting that antidepressants may increase risk of suicidal behaviour in young people. This evidence was accompanied by national and international guidelines cautioning against use of many antidepressants in young people. This study aimed to assess whether these safety warnings have impacted upon antidepressant utilisation rates. Method This study was based at a metropolitan health service incorporating children’s and adult hospitals. Total service utilisation of antidepressants was extracted from pharmacy software for the period January 2002 to December 2005. Monthly utilisation rates were computed for adults and children’s services as defined daily doses (DDD) per occupied bed days. Changes in utilisation over time were examined for children and adults. Results There was a significant relationship between time and antidepressant utilisation in children and adolescents, where antidepressant use decreased over time (R ¼ 0.474; t ¼3.66; p < 0.01), and in particular, use of SSRIs (R ¼ 0.461; t ¼3.52; p < 0.01). In contrast, use of SSRIs (R ¼ 0.587; t ¼ 4.91; p < 0.001) and all antidepressants (R ¼ 0.327; t ¼ 2.35; p < 0.05) increased over time in adults. Conclusions National and international warnings about safety of antidepressants in children and adolescents appear to have influenced local utilisation of these medications in young people but not in adults. Further research is required to determine optimal utilisation rates. Copyright # 2007 John Wiley & Sons, Ltd. key words — serotonin uptake inhibitors; antidepressive agents; suicide; paediatrics; drug utilisation; risk communication Received 31 December 2006; Revised 5 February 2007; Accepted 19 February 2007 INTRODUCTION Antidepressants are commonly used in children and adolescents for depression, anxiety and a variety of other disorders. 1–4 Antidepressant use has increased substantially over the recent decades, fuelled by the popularity of selective serotonin reuptake inhibitors (SSRIs). 1,2,5 However, emerging data have questioned the safety and efficacy of SSRI treatment for paediatric depression. In June 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) reanalysed published and unpublished data on the SSRI paroxetine, and found that they lacked significant beneficial effects and was associated with a small increase in suicide behaviour and ideation. The MHRA advised that paroxetine should not be used to treat depression in children younger than 18 years. 6 pharmacoepidemiology and drug safety 2007; 16: 1048–1053 Published online 16 April 2007 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/pds.1396 * Correspondence to: Dr A. J. Dean, Kids in Mind Research, Mater Child and Youth Mental Health Service, South Brisbane QLD 4001, Australia. E-mail: Angela.Dean@mater.org.au y No conflict of interest was declared. Copyright # 2007 John Wiley & Sons, Ltd.