BACKGROUND: The American Academy of Child and Adolescent Psychiatry (AACAP) has developed guidelines to provide recommendations to clinicians towards good treatment practices.One of the recommendations is that treatment for pediatric depressive disorders should be continued for 6 to 12 months to consolidate response and avoid relapses.
OBJECTIVES: To describe duration of first treatment episode (FTE) among new pediatric users of antidepressants and the pattern of adherence to the AACAP’s recommendation on the duration of therapy.
METHODS: PharMetrics, a national integrated healthcare claims database of managed care plans, was used to identify a cohort of new pediatric users of antidepressant drugs. New users were defined as individuals aged 1–17 years who had a first pharmacy claim for a prescription of an antidepressant with a date (index date) from January 1 through December 31, 2007, and who had not been prescribed with any antidepressant drug during the 6 months prior to the index date. Patients were followed for 1 year and classified into two groups according to their adherence to antidepressant treatment. Adherence when duration of FTE was 6 months and non-adherence when duration of the FTE was <6 months.
RESULTS: A total of 29,074 individuals were identified as new pediatric users of antidepressants. Overall, 35% of the patients were classified in the adherence group and 65% in the non-adherence group. The mean overall duration of the FTE was 4.5 months for the complete studied population, 7.4 months for the adherence group and 2.9 months for the non-adherence group. Psychiatrists were the most frequent prescribers for the FTE in the adherence group (21%) and general practitioners in the non-adherence group (20%). Compared to the non-adherence patients, patients in the adherence group had been prescribed with SSRIs (Selective serotonin reuptake inhibitors) more frequently (74% vs. 60%), had higher frequency of recorded diagnoses of a depressive disorder (44% vs. 36%), and greater frequency of concomitant psychotherapy (50% vs. 33%).
CONCLUSIONS: The duration of the first treatment episode was shorter than recommended by guidelines in 65% of the studied subjects.
