Antidepressant use in German adolescents with a first recorded diagnosis of depression: a retrospective cohort study

Depression is the most prevalent mental health disorder among adolescents worldwide. This study examined antidepressant prescribing and the distribution of prescribed drug classes and agents among adolescents with depression in Germany.

We conducted a retrospective cohort study using the IQVIA™ Disease Analyzer database, including patients aged 13-17 years who received a first recorded diagnosis of depression (ICD-10: F32, F33) between 2010 and 2023. One-year cumulative incidences of antidepressant prescriptions were estimated using Kaplan-Meier curves. Cox regression models assessed associations between demographic or clinical factors and prescribing.

The study included 9,724 adolescents (mean age 16 years; 67% female), with moderate depression in 54% of cases. Within 12 months, 61% received at least one antidepressant prescription. Prescription rates rose with age, from 39% at 13 years to 70% at 17 years. Selective serotonin reuptake inhibitors (SSRIs) were the predominant class, followed by serotonin-norepinephrine reuptake inhibitors (SNRIs), herbal antidepressants (St. John's Wort), and other agents such as mirtazapine. Fluoxetine was the leading SSRI, followed by sertraline and escitalopram. Co-occurring obsessive-compulsive disorder, eating disorders, and social phobia were associated with a significantly higher likelihood of receiving an antidepressant.

In German adolescents with depression, older age, greater symptom severity, and certain psychiatric comorbidities were strongly linked to antidepressant use. SSRIs were most frequently prescribed, particularly fluoxetine, with sertraline and escitalopram also common. St. John's Wort and mirtazapine were used less often. These findings underline the importance of considering age, severity, and coexisting psychiatric disorders when managing adolescent depression.