# Presentation: 111804

## SSRI Antidepressant Use and Rates of Suicide Attempt Among Adults with MDDandAn Evaluation of the FDA Warnings on Antidepressants and Suicidality onPatterns of Care for MDD

- Robert J. Valuck, PhD, RPh
- University of Colorado
- December 13, 2006

## Disclosures

- First Study
- Co-authors:  Anne Libby, Elaine Morrato, Robert Gibbons, Hendricks Brown, Maria Oquendo, and Richard Allen
- Funding:  none (unfunded, investigator-initiated)
- Second Study
- Co-authors:  Anne Libby, Elaine Morrato, Heather Orton, David Brent, Ross Baldessarini, and Richard Allen
- Funding:  unrestricted, investigator-initiated grant from Eli Lilly and Company

## SSRI Use and Rates of Suicide Attempt Among Adults with Major Depressive Disorder

- Study Design:    	Retrospective, new-user cohort
- Population:        	Adults (19 or older) with MDD (N=371,586)			-  New diagnoses (1yr free of MDD, ADRx, Psychotherapy)			-  12 months pre, 6 months post data available
- Data Source:     	PharMetrics Longitudinal Database (1995-2003)
- Outcome: 	        	Suicide Attempt (ICD-9: E950-E959)
- Analysis:	        	Rates, relative risks of Suicide Attempt
- 		                                -  SSRI Users vs. Nonusers		                -  By Age strata (19-24, 25-64, 65+)
- 			                -  Additional analyses underway
- 			          	      -  Propensity for treatment			      -  Other antidepressant drugs

## Rates of Suicide Attempt by Age Group

| 
 | 
SSRI ANTIDEPRESSANT USAGE |  |  |  |  |  | 

Risk Statistics |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  | 
SSRI |  |  | 
None |  |  |  |  |  |
| 
AGE GROUP | Suicide Attempts | Number of Subjects | 
Rate per 1,000 | 
Suicide Attempts | 
Number of Subjects | 
Rate per 1,000 | 
RR | 
Lower 95% CL | 
Upper 95%CL |
| 19-24 | 40 | 9,214 | 4.34 | 122 | 27,317 | 4.46 | 0.97 | 0.68 | 1.39 |
| 25-64 | 75 | 67,853 | 1.11 | 364 | 252,178 | 1.44 | 0.77 | 0.59 | 0.98 |
| 65+ | 2 | 2,810 | 0.71 | 10 | 12,214 | 0.82 | 0.87 | 0.19 | 3.96 |
| Overall | 117 | 79,877 | 1.47 | 496 | 291,709 | 1.70 | 0.86 | 0.70 | 1.05 |

## An Evaluation of the FDA Warnings on Antidepressants and Suicidality on Patterns of Care for MDD

- Study Design:   	Interrupted time series analysis of retrospective,				monthly cohorts of subjects with MDD
- Population:        	MDD according to HEDIS criteria (N=541,000)
- Data Source:     	PharMetrics Longitudinal Database (1998-2005)
- Measures:         	Rates of MDD Diagnosis in population, MDD 				treatment patterns (diagnosis, prescribing, and 				possible substitution effects)
- Interruption:      	First FDA PHA in October 2003
- 				  - 5 years “pre” data, 2 years “post” data
- Analysis:	        	Segmented regression analysis, adjusted for 				seasonality, pre-existing trends
- 			             - Run for both pediatric, adult populations

## Main Findings: Pediatric Population

- Rate of MDD Diagnosing in Population decreased
- Rate of diagnosed MDD per 1,000 enrollees dropped significantly
- Fraction of diagnosed episodes classified as “New” decreased (increasing fraction of recurrent episodes)
- Pediatricians, PCP’s diagnosing MDD less, Psychiatrists more
- Decrease in antidepressant prescribing
- Pediatricians, PCP’s, Psychiatrists all prescribing less, Other (known) specialists prescribing more (emergency medicine=highest)
- SSRIs being prescribed less, in favor of no antidepressant therapy
- No Major Substitution Patterns are Apparent
- No significant shifts towards increased use of psychotherapy, atypical antipsychotic or anxiolytic drugs in lieu of antidepressants

## Main Findings:  Adult Population

- Clear “spillover” effect into adult population
- Decreased rate of MDD diagnosis in the general population
- Higher fraction of recurrent vs. new MDD episodes
- Less diagnosing and prescribing by PCPs, more by Other specialties (no appreciable changes for Psychiatrists)
- Again, emergency medicine was highest “other” specialty group
- Less use of antidepressants (trend towards no drug therapy)
- No substitution effects observed (psychotherapy or other drugs)
- Conclusion:   patterns of care for MDD changed significantly after FDA advisories