Antidepressant Use in Medicaid-Insured Youth: Trends, Covariates, and Future Research Needs

Julie M Zito; Dinci Pennap; Daniel J Safer

doi:10.3389/fpsyt.2020.00113

Antidepressant Use in Medicaid-Insured Youth: Trends, Covariates, and Future Research Needs

Front Psychiatry. 2020 Mar 13:11:113. doi: 10.3389/fpsyt.2020.00113. eCollection 2020.

Authors

Julie M Zito^{1

2}, Dinci Pennap^{2

3}, Daniel J Safer⁴

Affiliations

¹ Department of Psychiatry, University of Maryland, Baltimore, MD, United States.
² Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, United States.
³ Center for Drug Evaluation and Research, United States Food and Drug Administration (FDA), Silver Spring, MD, United States.
⁴ Johns Hopkins Medical Institutions, Baltimore, MD, United States.

Abstract

Background: Detailed research on long-term antidepressant (AD) trends within a single large US Medicaid population of youth has not heretofore been reported.

Methods: Administrative claims data for eight annual timepoints across 28 years (1987-2014) were organized for youth (<20 years old) who were continuously enrolled during each study year in a mid-Atlantic state Medicaid program. Total annual AD prevalence and age-, gender-, race-, eligibility group-, and diagnosis-specific prevalence were formed from bivariate analyses; logistic regression assessed the change in use (2007-2014) adjusted for covariates. AD-polypharmacy data were assessed in 2014.

Results: The major findings are: 1) AD use in state Medicaid enrollees grew 14-fold between 1987 and 2014. Data from 2014 revealed significantly increased odds of youth with SSRI/SNRI dispensings compared to 2007 (AOR=1.15 95% CI 1.11-1.19), representing 78% of total AD users. 2) Recent AD increases were greatest for 15-19-year olds. 3) AD use in girls passed up AD use in boys for the first time in 2014. 4) In 2014, ADs for foster care (12.7%) were 6 times greater than for their income-eligible Medicaid-counterparts. 5) In 2014, a quarter of AD-medicated youth were diagnosed with a behavior disorder. 6) More than 40 percent of AD medicated youth had >=1 other concomitant psychotropic classes for 60 or more days.

Conclusions: Second-generation antidepressant use in Medicaid-insured youth has increased despite growing questions that pediatric AD benefits may not outweigh harms. These patterns support the call for publicly funded, independent investigator-conducted post-marketing outcomes research.

Keywords: Medicaid; adolescents; antidepressants; children; foster care; polypharmacy; trends.