Trends in prescribing and self-poisoning in relation to UK regulatory authority warnings against use of SSRI antidepressants in under-18-year-olds

center dot Ecological studies have shown conflicting evidence in relation to associations between trends in selective serotonin reuptake inhibitor (SSRI) prescription rates and suicide rates in adolescents. center dot After regulatory warnings in the UK against SSRI use in children and adolescents, prescribing of antidepressants in general declined in this group; there were no related changes in rates of suicide or hospital admissions for self-harm. WHAT THIS STUDY ADDS center dot Based on all presentations to general hospitals, nonfatal self-poisoning with SSRI antidepressants (but not fluoxetine) declined in 12-19-year-olds in three centres in England in line with UK prescribing trends. center dot There was some evidence of a possible small substitution effect from use of other SSRIs for nonfatal self-poisoning to use of fluoxetine center dot Overall rates of nonfatal self-harm in 12-19-year-olds in three centres in England were stable, indicating no major substitution of method to self-injury or overall adverse impact of the Medicines and Healthcare products Regulatory Authority warning. AIMS To assess the impact of the UK Medicines and Healthcare products Regulatory Authority (MHRA) warning in December 2003 not to prescribe selective serotonin reuptake inhibitor (SSRI) antidepressants, except fluoxetine, to under-18-year-olds. METHODS Interrupted time series analysis of prescriptions (UK) and general hospital presentations for nonfatal self-poisoning (three centres in England) for 2000-2006. RESULTS Following the MHRA warning in December 2003 there were significant decreases in prescribing of SSRI antidepressants (conservative estimate 51%) to young people aged 12-19 years. Surprisingly, this decrease also affected fluoxetine (conservative estimate 20%) and tricyclics (conservative estimate 27%). Nonfatal self-poisoning in this age group following the warning also declined significantly for SSRIs (conservative estimate 44%), but not for fluoxetine, tricyclic antidepressants, or all drugs and other substances. Rates of nonfatal self-harm did not change significantly over the study period. CONCLUSIONS The reduction in both prescribing and self-poisoning with SSRI antidepressants (except fluoxetine) following the MHRA warning is in keeping with reduced availability of these drugs. There was some evidence of substitution from other SSRIs to fluoxetine for use in self-poisoning. Importantly, overall rates of nonfatal self-harm and self-poisoning did not change, indicating no substitution of method or increases in self-injury.