Medication Management and Issues

Antidepressant Choices in Primary Care: Which to Use First?
The past 15 years have seen a tremendous growth in the number of new medications to treat a variety of psychiatric disorders. In 1998 fluoxetine (Prozac) was marketed in the United States and ushered in a new era of medication treatments for major depression and anxiety disorders. As of 2000, fluoxetine had reached $2 billion in United States sales and no drug marketed has received as much attention and study. Several other selective serotonin reuptake inhibitors (SSRIs) were marketed soon after and their ease of use, favorable side effect profile, and safety in overdose has made them the first-line pharmacotherapy for mood and anxiety disorders. Along with the SSRIs, other antidepressants with different mechanisms of action have also been marketed and several others are in the final stages of clinical trials. Antidepressants accounted for a staggering global market of $14.5 billion in 2003 and were the third-largest category of prescription medications behind antiulcerants and cholesterol-reducing agents.
Wisconsin Medical Journal Volume 103, Number 6 - 2004

AMA to Study Safety of SSRIs In Youngsters
"The decision is a response to the recognition that parents, physicians, and the public are confused and uncertain about the use of antidepressants in children and adolescents. Altha Stewart, M.D., chair of the Steering Committee to Reduce Disparities in Access to Psychiatric Care, discusses the committee's final report with former APA president Richard Harding, M.D., at last month's Board of Trustees meeting. See page 13 for coverage of the meeting. The AMA will prepare an independent and comprehensive review of the scientific data pertaining to safety and efficacy of using selective serotonin reuptake inhibitor (SSRI) antidepressants in the treatment of child and adolescent psychiatric disorders." Psychiatric News - 01/07/05

Antidepressant medication usage in the pediatric population
There has been a significant amount of interest and concern over the use of antidepressant medications in the pediatric population. In October 2004, the FDA recommended that the manufacturers of all antidepressant medications include a "black box" warning of the potential for suicidal thoughts and actions when a child is taking these medications. This "black box," which is prominently displayed on the drug package inserts, is used only to signify a significant risk associated with a particular medication. The FDA did acknowledge that the "black box" warning is not a contraindication to the use of these medications. There was also discussion as to whether to add to the medication labels information about the studies that often found no difference in effect of most of the antidepressant medications and a placebo, or sugar pill. This paper will discuss the recent history of antidepressant usage, the sequence of the process that led up to the warning, and speculation about the possible mechanisms for the action of the medications. There will be a brief discussion of the general process of the evaluation and treatment of a child with depression, and a brief summary with discussion of future directions in treatment. Wisconsin Medical Journal Volume 103, Number 6 - 2004