Discontinuation, Medication Switching, and Augmentation After SSRI in Pediatric Depression

To investigate antidepressant regimen change after an initial selective serotonin reuptake inhibitor (SSRI) trial in children and adolescents with depression, and to identify associated factors.

This population-based cohort study included children and adolescents aged 8 to 18 years with depression initiating SSRI monotherapy, using the 2010-2022 IQVIA PharMetrics Plus Closed Health Plan database (25% random sample). Eligible individuals received ≥8 weeks of SSRI treatment without switching or augmentation during the initial 12-week treatment. We estimated regimen change after week 12 and used a Cox proportional hazards regression model to identify factors associated with the change. Sensitivity analyses tested allowable treatment gaps and extended follow-up periods.

Of 20,708 individuals (mean age 15.4 years, 66.8% female), 11,067 (53.4%) changed their regimen: 9,369 (45.2%) discontinued, 1,137 (5.5%) switched, and 561 (2.7%) augmented. Older age (hazard ratio = HR 1.05, 95% CI = 1.04-1.06), substance use disorder (HR = 1.24, 95% CI = 1.14-1.34), psychiatric hospitalization (HR = 1.38, 95% CI = 1.19-1.61), and psychiatric emergency department visits (HR = 1.18, 95% CI = 1.04-1.35) were associated with an increased risk of regimen change. Anxiety disorder (HR = 0.89, 95% CI = 0.86-0.93) and psychotherapy (6-10 visits: HR = 0.90, 95% CI = 0.84-0.95; >10 visits: HR = 0.78, 95% CI = 0.73-0.82 vs none) were associated with a lower risk of regimen change. Individuals without a health maintenance organization (HMO) had a lower risk (HR = 0.92; 95% CI = 0.88-0.96) than those with an HMO. An extended follow-up identified additional regimen changes.

Our findings showed that over half of children and adolescents initiating antidepressant use do not continue treatment beyond 12 weeks.