ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2008
Effect of regulatory warnings on antidepressant prescription rates, use of health services and outcomes among children, adolescents and young adults.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 50 papers, 3 of them syntheses that pooled it.
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Who cites it
50 citing papers in PubMed, 3 syntheses or guidelines pooled it, 171 citations in OpenAlex.
- Measuring the impact of medicines regulatory interventions - Systematic review and methodological considerations.British journal of clinical pharmacology · 2018Pooled it
- Metasynthesis of youth suicidal behaviours: perspectives of youth, parents, and health care professionals.PloS one · 2015Pooled it
- Impact of safety-related regulatory action on clinical practice: a systematic review.Drug safety · 2012Pooled it
- International Trends in Antidepressant Consumption: a 10-year Comparative Analysis (2010-2020).The Psychiatric quarterly · 2025Observational
- Association between a publicly funded universal drug program and antipsychotic and antidepressant medication dispensing to children.BMC pediatrics · 2025Article
- Effectiveness comparisons of various psychosocial therapies for children and adolescents with depression: a Bayesian network meta-analysis.European child & adolescent psychiatry · 2021Review
- Response to "Black Box Warning Did Not Cause Increased Suicides".Psychiatric research and clinical practice · 2021Article
- Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care.Psychiatric research and clinical practice · 2020Article
- Adverse drug reactions in infants, children and adolescents exposed to antidepressants: a French pharmacovigilance study.European journal of clinical pharmacology · 2020Article
- Duty to Warn: Antidepressant Black Box Suicidality Warning Is Empirically Justified.Frontiers in psychiatry · 2020Review
- Prevalence and Determinants of Long-Term Utilization of Antidepressant Drugs: A Retrospective Cohort Study.Neuropsychiatric disease and treatment · 2020Article
- Trends in psychiatric disorders prevalence and prescription patterns of children in Alberta, Canada.Social psychiatry and psychiatric epidemiology · 2019Article
- Association Between Parental Medical Claims for Opioid Prescriptions and Risk of Suicide Attempt by Their Children.JAMA psychiatry · 2019Article
- Comparative, cross-sectional study of the format, content and timing of medication safety letters issued in Canada, the USA and the UK.BMJ open · 2018Article
- Screening for Depression in Pediatric Primary Care.Current psychiatry reports · 2018Review
- Long-Run Trends in Antidepressant Use Among Youths After the FDA Black Box Warning.Psychiatric services (Washington, D.C.) · 2018Article
- Les soins médicaux de jeunes hommes et de jeunes femmes qui décèdent par suicide.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2018Article
- Antidepressants in paediatric depression: do not look back in anger but around in awareness.BJPsych bulletin · 2018Article
- Impact of pioglitazone regulatory withdrawal on antidiabetic drug use and health in diabetic patients.European journal of clinical pharmacology · 2017Article
- The Impact of US FDA and Health Canada Warnings Related to the Safety of High-dose Simvastatin.Drugs - real world outcomes · 2017Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRegulatory bodies worldwide, including Health Canada, have issued warnings about prescribing antidepressants to children and adolescents. We sought to determine whether the Health Canada warning had the desired effects on prescribing patterns and outcomes and whether it had any unintended health consequences.
methodsWe examined data from prescription and health care databases representing more than 265 000 children, adolescents and young adults annually to determine changes in the rates of antidepressant prescription, use of health services and outcomes in these populations in the 9 years before and the 2 years after the Health Canada warning. We also examined the data for unintended changes in these rates among patients with anxiety disorders. We used young adults as the comparison group because they were not targeted by the warning.
resultsFollowing the warning, the rate of antidepressant prescriptions decreased among children and adolescents (relative risk [RR] 0.86, 95% confidence interval [CI] 0.81-0.91) and among young adults (RR 0.90, 95% CI 0.86-0.93). Ambulatory visits because of depression decreased among children and adolescents (RR 0.90, 95% CI 0.85-0.96) and young adults (RR 0.91, 95% CI 0.87-0.96). The rate of completed suicides among children and adolescents rose significantly after the warning (RR 1.25, 95% CI 1.08-1.44; annual rate per 1000 = 0.04 before and 0.15 after the warning). There was no equivalent change in the rate of completed suicides among young adults (RR 1.01, 95% CI 0.93-1.10; annual rate per 1000 = 0.15 before and 0.22 after the warning). Among patients with an anxiety disorder, the prescription rates did not change among children and adolescents, except for a decrease in the use of selective serotonin reuptake inhibitors other than fluoxetine, but the rates among young adults changed similar to the pattern of changes in the overall prescribing of antidepressants. There was also a significant decrease in the rate of physician visits because of anxiety disorders among young adults after the warning.
interpretationHealth advisories and warnings issued by regulatory bodies may have unintended consequences on the provision of care, delivery of health services and clinical outcomes. Further efforts are required to ensure that health warnings do not result in unexpected harm.
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