Long-term effects of regulatory warnings and increased media coverage on paroxetine and other SSRIs use

Background: In the periods 2003-2004 and 2007-2008 the regulatory banning of selective serotonin re-uptake inhibitors (SSRIs) in pediatrics and young adults because of concerns regarding suicidality coincided with negative media coverage. Objectives: We analyzed trends in SSRI use in the Netherlands (NL) and the United Kingdom (UK) in the period 2000-2010 and whether trend changes could be associated with the combined and long-term effect of both warnings and media coverage. Methods: Monthly SSRIs sales (IMS Health) were presented as DDD/1,000 inhabitants/day. Annual Dutch SSRI insurance claims data (GIP) were analyzed by age group. Trends in SSRI use were studied with time-series segmented regression analyses. Timing of trend changes was compared with the two warnings-coverage periods. Results: Trend changes in overall SSRI use largely corroborated with the warnings-coverage periods. Growth in overall SSRI use in the UK declined from 3.9 to 0.7 DDD/month (95% CI: 3.3;4.50.5;0.9, respectively) before the first warning period. A small dip of -0.6 DDD/month (-1.2;-0.05) was observed in overall NL SSRI use after the first period. During the second warning period, overall UK SSRI use stabilized, whilst overall NL SSRI use slightly decreased with -0.04 DDD/month (-0.4;0.3). Stratified analyses showed a rapid decrease of -1.2 DDD/ month (-2.1;-1.7) in UK paroxetine use before the first period, and a minimal change in NL paroxetine use (-0.3, -0.8;0.2). Other SSRI use, (es)citalopram, significantly increased at the same time. Significant reductions in Dutch paroxetine use were observed in pediatrics, adolescents, and young adults that started before the first period. Conclusions: Changes in overall SSRI use (NL UK) were associated with the timing of the combined effect of media coverage and regulatory warnings. Short-term studies only provide a snapshot of the implications. We confirmed changes observed in these studies, but our long-term assessment shows that these changes were temporal, drug specific, and pronounced in young groups. The long-term growth pattern of SSRI use indicates that regulatory warnings and media coverage may slow down, but not confine SSRI use as a class.