(256) Use of Medications with Depression and Suicidal Adverse Effects Among Children, Adolescents, and Young Adults in the United States

Background: Despite the growing burden of depression and rise in suicide in younger populations, the cumulative use of medications associated with depression symptoms is not known.

Objectives: To characterize trends and patterns in the use of prescription medications with depression or suicidality as a potential adverse effect (AE) among children, adolescents, and young adults in the US.

Methods: A serial cross-sectional study using a nationally representative 5% random sample of anonymized, longitudinal, pharmacy claims from IQVIA LRx between January 1, 2011, and December 31, 2020. Micromedex was used to classify prescription medications with potential depression and suicidality AE, including black-box warnings (BBW). Analyses were limited to the use and concurrent use of chronic medications individually and by therapeutic class. Concurrent use was defined by dispensing date and overlapping days’ supply. We estimated prevalence in the use and concurrent use of prescription medications with depression or suicidality as a potential AE overall and by age group and gender. Age groups include children (aged 6-11 years), adolescents (aged 12-17 years), and young adults (aged 18-25 years).

Results: Use of ≥1 medication with depression (27.5% v 34.5%) or suicidal (18.5% v 23.8%) AEs, or BBW (11.2% v 17.1%) increased significantly among younger populations between 2011 and 2020, respectively (p <.0001). Use of these medications varied substantially by gender; girls experienced a greater relative increase in the use and concurrent use of medications with AEs than boys. This trend was primarily driven by the use and concurrent use of hormonal contraceptives, antidepressants, ADHD, and antipsychotic medications by adolescent and young adult girls. Among adolescent and young adult boys, the use of ADHD medications, antidepressants, and leukotriene modifiers increased during this period. In contrast among children, the use of anticonvulsants and antihistamines associated with depression and suicidal AEs increased in both boys and girls. While the concurrent use of antidepressants with hormonal contraceptives was the most common among girls, concurrent use of ADHD medications with antidepressants or antipsychotics was the most common among boys.

Conclusions: In this study of medications dispensed to US children, adolescents, and young adults, use of chronic medications with potential depression or suicidal AEs increased between 2011 and 2020. By 2020, 1 in 3 were using ≥1 medication associated with an increased risk for depression or suicide and 1 in 6 were using ≥1 medication with a BBW for such a risk. Efforts to address the growing burden of depression in younger populations should consider the role of medications.