JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. the Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, April 2, 2007)
BABIES WHO DON’T RESPOND TO THEIR NAMES MAY BE AT RISK FOR DEVELOPMENTAL DISORDERS, INCLUDING AUTISM
AUTISM COSTS SOCIETY AN ESTIMATED $3 MILLION PER PATIENT
INFANTS WITH AUTISTIC SIBLINGS MAY DISPLAY EARLY SOCIAL, COMMUNICATION PROBLEMS
EDITORIAL: COMBINATION OF EARLY DETECTION, TIMELY TREATMENT HOLD PROMISE FOR AUTISM
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Audio Interviews
Interview with Frederick Rivara, M.D., M.P.H., editor, Archives of Pediatrics & Adolescent Medicine
Interview with Sally Ozonoff (OH-zon-off), Ph.D., second author of "A Prospective Study of Response to Name in Infants at Risk for Autism" (Arch Pediatr Adolesc Med. 2007;161:378-383.)
Interview with Michael Ganz, M.S., Ph.D., author of “The Lifetime Distribution of the Incremental Societal Costs of Autism” (Arch Pediatr Adolesc Med. 2007;161:343-349.)
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, April 2, 2007)
STROKES MAY BE ASSOCIATED WITH COCAINE AND AMPHETAMINE ABUSE
FEWER CHILDREN AND TEENS RECEIVED ANTIDEPRESSANTS FOLLOWING FDA WARNINGS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access.
Please Note: In conjunction with the release of the Archives of Pediatrics & Adolescent Medicine theme issue on autism spectrum disorders, radio actualities from two of the researchers and an audio news story featuring the journal editor, Frederick Rivara, M.D., M.P.H., will be available in mp3 format on www.jamamedia.org at 3 p.m. CT on Monday, April 2.
Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 2, 2007
Media Advisory: To contact co-authors Aparna S. Nadig, Ph.D., Sally Ozonoff, Ph.D., or Sally Rogers, Ph.D., call Karen Finney at 916-734-9064.
BABIES WHO DON’T RESPOND TO THEIR NAMES MAY BE AT RISK FOR DEVELOPMENTAL DISORDERS, INCLUDING AUTISM
CHICAGO—Year-old babies who do not respond when their name is called may be more likely to be diagnosed with an autism spectrum disorder or other developmental problem at age 2, making this simple test a potential early indicator for such conditions, according to a report in the April issue of Archives of Pediatrics & Adolescent Medicine, a theme issue on autism spectrum disorders.
Although as many as half of parents of children with autism report concerns about their child’s developmental progress before the first birthday, the disorder is usually not diagnosed until age 3 or 4, according to background information in the article. “Earlier identification of autism offers the possibility of early intervention, which holds promise for improving outcomes in children with autism,” the authors write. “This has motivated a growing body of research that aims to ascertain the earliest reliable indicators of autism.”
Aparna S. Nadig, Ph.D., of the M.I.N.D. Institute, University of California Davis, Sacramento, and colleagues assessed the tendency of infants to respond when their names are called, which is “one of the most consistently documented behaviors in infancy that distinguishes children later diagnosed with autism from those with typical development or developmental delays,” they write.
Infants whose older siblings had autism, and who were therefore at risk for autism, were compared with control infants who were not at high risk of developing the disorder. While each child sat at a table playing with a small toy, a researcher walked behind the child and called his or her name in a clear voice. If the child did not respond after 3 seconds, the name was called again up to twice. Fifty-five at-risk infants and 43 control infants completed this test at age 6 months, and 101 at-risk infants and 46 control infants were tested at age 12 months.
“At age 6 months, there was a non-significant trend for control infants to require a fewer number of calls to respond to name than infants at risk for autism,” the authors write. “At age 12 months, 100 percent of the infants in the control group ‘passed,’ responding on the first or second name call, while 86 percent in the at-risk group did.”
Forty-six at-risk infants and 25 control infants were followed up for two years; three-fourths of those who did not respond to their name at age 12 months were identified with developmental problems at age 2. A total of 89 percent of infants who did not have an autism spectrum disorder (including autism, Asperger’s syndrome and related conditions all defined by deficits in language and social skills) and 94 percent of infants without any developmental delays at two years responded to their name on the first two calls at one year. Of the children who were later diagnosed with autism, half failed the test at one year, and of those who were identified as having any type of developmental delay, 39 percent failed the test.
“Thus, failure to respond to name at the well-child one-year check-up may be a useful indicator of children who would benefit from a more thorough developmental assessment,” the authors write. “It will not, however, identify all children at risk for developmental problems.”
“Since this task is easy to administer and score and takes few resources, it could be incorporated into well-child pediatric visits at 12 months of age,” they conclude. “If a child fails to orient to name, particularly reliably over time, this child has a high likelihood of some type of developmental abnormality and should be referred for more frequent screening, comprehensive assessment and, if indicated, preventive early intervention.”
(Arch Pediatr Adolesc Med. 2007;161:378-383. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was funded by a grant from the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
PLEASE NOTE: Radio actualities from second author Sally Ozonoff, Ph.D., will be available in mp3 format on www.jamamedia.org at 3 p.m. CT on Monday, April 2.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 2, 2007
Media Advisory: To contact Michael L. Ganz, M.S., Ph.D., call Peter Broderick at 617-349-2882.
AUTISM COSTS SOCIETY AN ESTIMATED $3 MILLION PER PATIENT
CHICAGO—Each individual with autism accrues about $3.2 million in costs to society over his or her lifetime, with lost productivity and adult care being the most expensive components, according to a report in the April issue of Archives of Pediatrics & Adolescent Medicine, a theme issue on autism spectrum disorders.
Autism costs society more than $35 billion in direct and indirect expenses each year, according to background information in the article. Relatively little is known about when these costs occur across the lifetime of an individual with autism.
Michael L. Ganz, M.S., Ph.D., Abt Associates Inc., Lexington, Mass., and Harvard School of Public Health, Boston, used data from the medical literature and from national surveys to estimate the direct medical and non-medical costs of autism, including prescription medications, adult care, special education and behavioral therapies. Approximate indirect costs, including lost productivity of both individuals with autism and their parents, were calculated by projecting average earnings and benefits at each age, adjusted for the fact that some autistic individuals can work in supported environments. Only costs directly linked to autism, and no medical or non-medical costs that would be incurred by individuals with or without autism, were included.
These costs were projected across the lifetime of a hypothetical group of individuals born in 2000 and diagnosed with autism in 2003. Costs estimates were broken down into age groups at five-year intervals, with the youngest group age 3 to 7 years and the oldest age 63 to 66 years.
“Direct medical costs are quite high for the first five years of life (average of around $35,000), start to decline substantially by age 8 years (around $6,000) and continue to decline through the end of life to around $1,000,” Dr. Ganz writes. “Direct non-medical costs vary around $10,000 to approximately $16,000 during the first 20 years of life, peak in the 23- to 27-year age range (around $27,500) and then steadily decline to the end of life to around $8,000 in the last age group. Indirect costs also display a similar pattern, decreasing from around $43,000 in early life, peaking at ages 23 to 27 years (around $52,000) and declining through the end of life to $0.”
Over an individual’s life, lost productivity and other indirect costs make up 59.3 percent of total autism-related costs. Direct medical costs comprise 9.7 percent of total costs; the largest medical cost, behavioral therapy, accounts for 6.5 percent of total costs. Non-medical direct costs such as child care and home modifications comprise 31 percent of total lifetime costs.
Because these costs are incurred by different segments of society at different points in an autistic patient’s life, a detailed understanding of these expenses could help planners, policymakers and families make decisions about autism care and treatment, Dr. Ganz notes. “Although autism is typically thought of as a disorder of childhood, its costs can be felt well into adulthood,” he concludes. “These results may imply that physicians and other care professionals should consider recommending that parents of children with autism seek financial counseling to help plan for the transition into adulthood.”
(Arch Pediatr Adolesc Med. 2007;161:343-349. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
PLEASE NOTE: Radio actualities from Michael L. Ganz, M.S., Ph.D., will be available in mp3 format on www.jamamedia.org at 3 p.m. CT on Monday, April 2.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 2, 2007
Media Advisory: To contact Wendy L. Stone, Ph.D., call Craig Boerner at 615-322-4747.
INFANTS WITH AUTISTIC SIBLINGS MAY DISPLAY EARLY SOCIAL, COMMUNICATION PROBLEMS
CHICAGO—Younger siblings of children with autism spectrum disorders do not perform as well on tests of social and communication development compared with siblings of children without developmental problems at ages as young as 12 months, according to a report in the April issue of Archives of Pediatrics & Adolescent Medicine, a theme issue on autism spectrum disorders.
Studies of twins and families indicate that autism and related disorders have a genetic basis, according to background information in the article. This includes milder conditions known as the “broader autism phenotype,” consisting of traits that are similar to those associated with autism but are not severe enough to cause disability. Approximately 6 to 9 percent of younger siblings of children with autism spectrum disorders (including autism and related conditions) develop autism spectrum disorders, and others may demonstrate features of the broader autism phenotype.
Wendy L. Stone, Ph.D., and colleagues at Vanderbilt University, Nashville, Tenn., studied 64 younger siblings of children with autism spectrum disorders and 42 younger siblings of children with typical development. The siblings were between the ages of 12 and 23 months (average age 16 months) when they were assessed between 2003 and 2006. Participating children were measured using tests of thinking, learning and memory; an interactive screening tool assessing play, imitation and communication; and a scale rating autism symptoms. Parents were also interviewed and filled out questionnaires regarding their children’s social, communication and language skills.
“Younger siblings of children with autism spectrum disorders demonstrated weaker performance in non-verbal problem-solving, directing attention, understanding words, understanding phrases, gesture use and social-communicative interactions with parents, and had increased autism symptoms, relative to control siblings,” the authors write. The pattern of scores on tests suggested that a substantial minority of the siblings of autistic children had low scores, as opposed to a few extremely low performers who may have deceptively brought down the average scores. In addition, “the consistency of results obtained across different methods highlights the robustness of these findings.”
The weaker performance of siblings of children with autism spectrum disorder may represent early signs of the broader autism phenotype, and highlights the importance of closely monitoring these at-risk children for developmental problems, the authors note. “This research has the potential to increase our knowledge about the early development of autism and to develop tailored intervention and prevention strategies for promoting optimal outcomes in this group of at-risk children,” they conclude.
(Arch Pediatr Adolesc Med. 2007;161:384-390. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by grants from the National Institute of Child Health and Human Development; a Mentor-Based Postdoctoral Fellowship from the National Alliance for Autism Research; and in part by the Vanderbilt University Kennedy Center Marino Autism Research Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 2, 2007
Media Advisory: To contact Geraldine Dawson, Ph.D., call Joel Schwarz at 206 685-0658. To contact David J. Schonfeld, M.D., call Jim Feuer at 513-636-4656.
EDITORIAL: COMBINATION OF EARLY DETECTION, TIMELY TREATMENT HOLD PROMISE FOR AUTISM
Studies on autism highlighted in Archives of Pediatrics & Adolescent Medicine theme issue
CHICAGO—Emerging genetic research may help scientists recognize children with autism at a younger and potentially treatable age, according to an editorial in the April issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. The issue is devoted to studies of autism spectrum disorders.
Children and adults with autism, a chronic developmental disorder, have difficulty with social and language skills and often display repetitive behaviors, according to background information in the articles. Symptoms usually appear by age 3. Much progress has been made in understanding autism and related conditions—known collectively as autism spectrum disorders—in the past 15 years. Still, significant mystery continues to surround its risk factors and possible causes, presenting challenges to scientists working to develop effective treatments.
“As autism susceptibility genes are discovered, the hope is that such risk genes—in combination with other behavioral, electrophysiologic and magnetic resonance imaging indices—might allow for very early identification of infants at risk for autism, thus offering the opportunity to prevent the full-blown syndrome,” writes Geraldine Dawson, Ph.D., of the Autism Center at the University of Washington, Seattle. “In the meantime, behavioral interventions that are appropriate for very young children with autism are becoming increasingly sophisticated and effective, at least for a substantial subgroup of children with this disorder.”
“Thus, a combination of very early identification and early behavioral intervention holds promise for significantly altering the course of brain and behavioral development and outcome in individuals with autism,” she continues.
The autism theme issue of the journal “highlights new approaches to the early identification and treatment of autism, and the associated financial and emotional costs to families and society,” Dr. Dawson writes. Papers published in the issue find that:
- Older fathers and mothers may be at increased risk of having a child with an autism spectrum disorder
- In addition to maternal and paternal age, low birth weight, a shorter pregnancy and a period during birth when the baby does not get enough oxygen may be associated with an increased risk for autism spectrum disorders
- Yearly health care expenses for individuals with autism spectrum disorders increased 20.4 percent per patient between 2000 and 2004, from $4,965 to $5,979
- Nearly one-third of parents do not appear to comply with instructions given when their children screen positive for problems with social development
The findings of the last two studies highlight the need for improved assistance to families dealing with this condition, write David J. Schonfeld, M.D., and Patty Manning-Courtney, M.D., of the Cincinnati Children’s Hospital Medical Center, Ohio, in a second editorial. “While the next decade holds much promise for a better understanding of autism etiology and treatment, there is much to be done today at every level of health care and throughout our society to identify children with autism spectrum disorders early in their development so that we can provide ready access to needed services and support for their families,” they conclude.
(Arch Pediatr Adolesc Med. 2007;161:411-412, 334-340, 326-333, 350-355, 363-368, 412-413. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
PLEASE NOTE: In conjunction with the release of the Archives of Pediatrics & Adolescent Medicine theme issue on autism spectrum disorders, radio actualities from two of the researchers and an audio news story featuring the journal editor, Frederick Rivara, M.D., M.P.H., will be available in mp3 format on www.jamamedia.org at 3 p.m. CT on Monday, April 2.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE AUDIO INTERVIEWS
Interview with Frederick Rivara, M.D., M.P.H., editor, Archives of Pediatrics & Adolescent Medicine
CLIP (mp3 file)
Transcript:
THIS IS MAVIS PRALL WITH THE ARCHIVES OF PEDIATRICS AND ADOLESCENT MEDICINE. ABOUT ONE IN EVERY 150 AMERICAN CHILDREN HAS AUTISM. THE GOOD NEWS IS DOCTORS KNOW MORE KNOW ABOUT AUTISM THAN EVER BEFORE.
“We’re beginning to understand a little bit more about how to identify these children earlier and the reason that’s so important is there’s good evidence that treatment is effective.” Runs :10
THAT’S DR. FRED RIVARA, EDITOR OF THE ARCHIVES JOURNAL, WHICH HAS PUBLISHED A THEME ISSUE ON AUTISM SPECTRUM DISORDERS. HE SAYS NO ONE KNOWS WHAT CAUSES AUTISM, BUT…09
“We clearly know that there is some genetic basis to it and I think that research into the genetics of autism will in all likelihood be able to lead to earlier if not pre-natal diagnosis. Runs :10
BUT HE SAYS THAT COULD BE A DECADE AWAY, AND IN THE MEANTIME…
“One of the papers in this issue shows that the lifetime cost for autism for a single individual is over three million dollars,” :08
SO HE SAYS MORE RESEARCH NEEDS TO BE DONE ON HOW TO HELP FAMILIES COPE WITH AUTISM, AND HOW TO TREAT AND SOMEDAY PREVENT IT. THIS IS MAVIS PRALL WITH THE ARCHIVES OF PEDIATRICS AND ADOLESCENT MEDICINE.
Interview with Sally Ozonoff, Ph.D., second author of “A Prospective Study of Response to Name in Infants at Risk for Autism”
(Arch Pediatr Adolesc Med. 2007;161:378-383.)
CLIP 1 (mp3 file)
CLIP 2 (mp3 file)
CLIP 3 (mp3 file)
CLIP 4 (mp3 file)
Transcript:
Clip 1: We wanted to figure out how to identify autism as early as possible so treatment could be started when the brain is most changeable and therefore have the most impact. Runs :10
Clip 2: Almost all children in our study who failed to respond to their name at 12 months of age had some later developmental problems. About half had autism and the others had speech or general developmental delays. Runs :14
Clip 3: If a child didn’t respond once or twice it’s nothing really to worry about. We’re looking for a consistency of pattern over time. But if a parent noticed that their child consistently doesn’t turn around when they call their name, they should bring that information to their pediatrician right away. Runs :16
Clip 4: Failure to respond to name at 12 months identified about half of the children with autism in our sample but not all. So it’s important for parents to look at a variety of other things at 12 months: their children should be smiling at them, looking at their faces and eyes, should be showing them things, pointing to things and if they’re not doing that, then that’s cause for concern as well. Runs :24
Interview with Interview with Michael Ganz, M.S., Ph.D., author of “The Lifetime Distribution of the Incremental Societal Costs of Autism”
(Arch Pediatr Adolesc Med. 2007;161:343-349.)
CLIP 1 (mp3 file)
CLIP 2 (mp3 file)
CLIP 3 (mp3 file)
Transcript:
Clip 1: The total lifetime costs are 3.2 million dollars per person with autism. These are specific to autism only. It wouldn’t be including things that would have been incurred anyway. Runs :09
Clip 2: That overall number masks the fact that costs vary over the lifetime. They’re very high in early age, taper off and then spike again at early adulthood, due to things like adult care and lost productivity. Runs :13
Clip 3: Parents of children with autism might want to seek financial counseling to plan for these costs later in life. However, recognizing that not all families can bear these costs of autism, these results are a starting point for society to think about how we can help these families. Runs :15
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 2, 2007
Media Advisory: To contact corresponding author Robert W. Haley, M.D., call Katherine Morales or Donna Hansard at 214-648-3404.
STROKES MAY BE ASSOCIATED WITH COCAINE AND AMPHETAMINE ABUSE
CHICAGO—The use of stimulant drugs, including cocaine and amphetamines, may be linked to a higher risk for stroke, according to a report in the April issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
“Evidence has been accumulating for two decades supporting a link between abuse of stimulant drugs and strokes in young people,” the authors write as background information in the article. Cocaine, amphetamines and other stimulants may increase the risk of stroke by raising blood pressure or contributing to narrowing blood vessels by triggering spasms in the vessel walls.
Arthur N. Westover, M.D., of The University of Texas Southwestern Medical Center at Dallas, and colleagues used a database of 3,148,165 discharges from Texas hospitals between 2000 and 2003 to assess the connection between drug use and strokes. Strokes and drug dependence or abuse were identified by clinical codes.
In the four-year period, there were 8,369 strokes: 1,887 in 2000, 2,097 in 2001, 2,133 in 2002 and 2,252 in 2003. Cocaine was the second most frequently abused drug after alcohol, and amphetamines were the fifth; abuse of both, as well as cannabis and opioids, increased significantly.
In 2003—the only year that codes identified the difference between hemorrhagic (bleeding within the brain) and ischemic (blocked blood flow to the brain) strokes—amphetamine abuse was associated with a five-fold greater risk of hemorrhagic stroke but not ischemic stroke. Cocaine abuse was associated with more than double the risk of both hemorrhagic and ischemic stroke. “Amphetamine, but not cocaine, abuse was associated with a higher risk of death after hemorrhagic stroke,” the authors continue.
“The public health implications of these findings are heightened by growing news accounts suggesting a recent increase in methamphetamine abuse, particularly in the southwestern, western and Midwestern states,” they conclude. “This concern was supported by our finding that, among hospitalized patients in Texas from 2000 to 2003, the rate of amphetamine abuse was increasing faster than that of any other drug, including cocaine, and the rate of strokes among amphetamine abusers was increasing faster than the rate of strokes among abusers of any other drug.”
(Arch Gen Psychiatry. 2007;64:495-502. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported in part by a grant from the National Institute of Mental Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 2, 2007
Media Advisory: To contact corresponding author Amil Kalali, M.D., call Dick Jones at 919-998-2091.
FEWER CHILDREN AND TEENS RECEIVED ANTIDEPRESSANTS FOLLOWING FDA WARNINGS
CHICAGO—The number of children and teenagers prescribed antidepressant medications appears to have decreased following public warnings about suicidal behavior potentially associated with the drugs, according to a report published in the April issue of Archives of General Psychiatry, one of the JAMA/Archives journals. In addition, antidepressants are now more often prescribed to this age group by psychiatrists rather than primary care physicians.
The U.S. Food and Drug Administration (FDA) issued a public health advisory on Oct. 27, 2003, warning of an increased risk of suicidality (suicide attempts or suicide-related behavior) among children and teens taking antidepressants, according to background information in the article. A much-publicized hearing was held on the topic in February 2004. On March 22, 2004, the FDA issued another advisory instructing manufacturers to include a black-box warning on product labels recommending close monitoring of adults and children taking antidepressants. Conflicting information has since been presented regarding whether these warnings had any effects on prescription patterns.
Charles B. Nemeroff, M.D., Ph.D., Emory University School of Medicine, Atlanta, and colleagues analyzed prescription data and information from physician surveys provided by Verispan, a Pennsylvania-based health care information company. The prescription data capture about 55 percent of all U.S. retail pharmacy claims, including private payers, Medicaid and cash transactions—more than 1.4 billion prescriptions per year. The physician survey involved approximately 3,400 office-based physicians across 29 specialties, and is projected out to provide a representative view of diagnoses and prescriptions in the United States.
Upon analyzing the data from 2000 to 2005, the researchers found that “the growth in total antidepressant prescriptions seemed to begin to slow around the timing of the public health advisories in October 2003 and March 2004 about pediatric suicidality,” they write. “However, by the time the FDA panel met to discuss the data findings in September 2004, the proceedings from the meeting had little effect on the market—behavior had already been altered.” Prescriptions of antidepressants to patients younger than 18 years increased by .79 percent per month from April 2002 to February 2004, decreased by 4.23 percent per month from February 2004 to July 2004 and stabilized from July 2004 to March 2005.
In addition, “there has been a shift in the providers of care of depressed patients younger than 18 years away from primary care and other providers to psychiatrists,” the authors write. From December 2003 through February 2004, psychiatrists accounted for 44 percent of patient care for those younger than 18 years. From December 2004 through February 2005, psychiatrists cared for 63 percent of pediatric and adolescent depressed patients.
The only antidepressant approved by the FDA for use in pediatric patients is fluoxetine, which is a member of a class known as selective serotonin reuptake inhibitors (SSRIs). However, the analyses also showed a trend toward prescribing bupropion, a non-SSRI antidepressant, to young patients. This trend “could stem in large part from physicians attributing the increased risk of suicidality primarily to SSRIs, even though bupropion is also labeled with a black box warning.”
Although the findings do not speak to whether these changes in prescriptions are appropriate, they do indicate that the warnings have had an effect, the authors write. It is also unclear how warnings about suicidality and antidepressants in older patients will change the treatment of depression. “It is evident, however, that there is need for additional exploration into the relationship between FDA action, media reaction and physician behavior change to ensure that dissemination of drug safety information does not interfere with appropriate access to care,” the authors conclude.
(Arch Gen Psychiatry. 2007;64:466-472. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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