gms | German Medical Science

15th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

20.11. - 21.11.2008, Bonn

Changes in Antidepressant Prescribing Patterns in Germany and the Netherlands in the Context of SSRI Warnings

Antidepressiva-Verordnungen für Kinder und Jugendliche in Deutschland und den Niederlanden vor und nach den SSRI-Warnhinweisen

Meeting Abstract

  • corresponding author Katrin Janhsen - Centre for Social Policy Research, University of Bremen, Bremen, Germany
  • Lolkje TW de Jong-van den Berg - Department for Social Pharmacy & Pharmacoepidemiology, University of Groningen, Groningen,The Netherlands
  • Gerd Glaeske - Centre for Social Policy Research, University of Bremen, Bremen, Germany
  • Michael G. Koelch - Department of Child & Adolescent Psychiatry / Psychotherapy, University of Ulm, Ulm, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bonn, 20.-21.11.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08gaa28

The electronic version of this article is the complete one and can be found online at:

Published: November 6, 2008

© 2008 Janhsen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background and aim: In 2003 black-box warnings regarding the use of SSRIs in youths were published in GB and the US because associations with increasing suicidality were seen. Other countries adopted the warnings in the following years. After the warnings AT prescribing patterns have changed in several countries (Gibbons et al., 2007) and a lively discussion about the effects has started. Little is known about details of AT after black-box warnings in European countries. Aim of the project was to identify and characterize changes in AT prescribing patterns after black-box warnings in the Netherlands (NL) and Germany (D).

Material and method: Data analysis is based on prescribing data of the statutory health-insurance company GEK in D (around 360,000 enrollees aged 0-19 y per year) and the interaction database IADB in NL (around 120,000 enrollees aged 0-19 y per year) for the calendar years 2002-2006. Age- and sex-related prevalences and incidences including 95% confidence intervals for antidepressant subclasses were calculated.

Results: Between 2002 and 2006 AT prevalences decreased from 0.54 to 0.36% with relevant sex differences (females 0.63 to 0.48%, males 0.46 to 0.25%) in NL and increased from 0.20% to 0.25% (females 0.24 to 0.31%, males 0.17 to 0.20%) in D.

The highest SSRI prevalences were found among 15-19 year old female enrollees but with opposite national time trends. The maximum SSRI prevalences in these subgroup were 1.38% (NL, 2003) and 0.85% (D, 2006) and the minimum prevalences were 0.58% (NL, 2005) and 0.31% (D, 2003).

Conclusion: The effect of black box warnings regarding AT prescribing patterns shows national differences. The ongoing discussion about associations between SSRI prescriptions and suicide rates needs more data from high level study types considering other potentially influencing parameters.