Depression Treatment and Substance Abuse

描述（由申请人提供）：患有物质使用障碍（SUD）的人患精神疾病的比率远高于其他人群。一项为期10年的国家共病调查的纵向随访证实，与没有严重抑郁症的人相比，基线时患有重度抑郁症的人发展为尼古丁依赖的几率高出40%，在随后的十年中开始使用非法药物的几率高出90%。考虑到在儿科人群中有一系列基于证据的治疗方法，以及70%的sud首次出现在20岁之前，抑郁症和sud之间的关联开启了成功治疗儿科抑郁症可能减轻sud不良后果的可能性。然而，关于抑郁症治疗是否可以减轻sud和/或其后果的严格证据很少，因为很难确定是抑郁症导致药物使用，还是相反，或者是否有第三个因素在抑郁症和sud之间产生了虚假的相关性。为了研究抑郁症治疗如何预防或改变sud的发病和后果，我们建议利用一个强大的自然实验：2004年食品和药物管理局（FDA）关于儿童使用抗抑郁药有自杀风险的警告，导致抗抑郁药处方模式和使用的突然变化。这些警告被大众媒体广泛报道，导致确诊抑郁症的比例下降，并使患有抑郁症的儿科患者中抗抑郁药的使用减少了20%至30%，使这成为一项罕见而有力的自然实验。此外，在FDA发出警告后，处方模式和抗抑郁药使用的突然变化与美国青少年自杀率在15年相对稳定下降后上升14%相吻合，这意味着这些警告深刻地影响了抑郁症状。拟议的研究利用三个数据来源，共同提供关于药物使用、滥用和依赖、医疗保健利用（包括处方药数据）以及学术和犯罪相关成果的信息，旨在：1)检查FDA关于儿童抗抑郁药使用的警告以及伴随的儿童抗抑郁药使用的下降是否增加了物质使用、滥用和依赖（对于烟草、酒精、非法药物和非法使用处方药）的发作或强度；2)检查FDA关于儿童抗抑郁药使用的警告以及伴随的儿童抗抑郁药使用的下降是否增加了医疗保健使用和成本；3)检查FDA关于儿童抗抑郁药物使用的警告以及伴随的儿童抗抑郁药物使用的下降是否增加了药物使用、滥用和依赖的社会成本（医疗保健使用、学习成绩差、犯罪、犯罪活动）。我们的分析将使用回归不连续设计来比较2004年FDA对儿童使用抗抑郁药发出警告之前和之后新发抑郁症的青少年的处方模式和SUD结果。

DESCRIPTION (provided by applicant): Rates of mental illness are much higher among people suffering from a substance use disorder (SUD) than in the rest of the population. A 10-year longitudinal follow-up of the National Comorbidity Survey confirmed that individuals with major depression at baseline had 40% higher odds of developing nicotine dependence and 90% higher odds of initiating the use of illicit drugs in the subsequent decade compared to individuals without major depression. Associations between depression and SUDs open the possibility that the successful treatment of pediatric depression could mitigate adverse consequences of SUDs, given an array of evidence-based treatments in pediatric populations and the fact that 70% of SUDs first emerge by the age of 20. However, rigorous evidence on whether depression treatment could mitigate SUDs and/or their consequences is scant, because it is difficult to ascertain if depression causes substance use, the reverse, or whether a third factor generates a spurious correlation between depression and SUDs. To examine how depression treatment may prevent or alter the onset and consequences of SUDs, we propose to take advantage of a powerful natural experiment: the sudden change in the prescribing patterns and use of antidepressants induced by the Food and Drug Administration's (FDA's) 2004 warnings on the risks of suicidality associated with pediatric antidepressant use. The warnings were extensively covered by the popular press, led to documented decreases in rates of identified depression, and reduced antidepressant use by 20 to 30% among pediatric patients with depression, making this a rare and powerful natural experiment. Furthermore, this abrupt change in prescribing patterns and use of antidepressants after the FDA warnings coincided with a 14% rise in youth suicide in the U.S. after 15 years of relatively steady decline in suicide rates, implying that the warnings profoundly affected depressive symptoms. Using three data sources that together provide information on substance use, abuse, and dependence, medical care utilization (including data on prescription drugs), and academic and crime related outcomes, the proposed research aims to: 1) Examine whether FDA warnings regarding pediatric antidepressant use and the concomitant drop in pediatric antidepressant use increased the onset or intensity of substance use, abuse, and dependence (for tobacco, alcohol, illicit drugs, and illicit use of prescription drugs); 2) Examine whether FDA warnings regarding pediatric antidepressant use and the concomitant drop in pediatric antidepressant use increased health care use and costs; and 3) Examine whether FDA warnings regarding pediatric antidepressant use and the concomitant drop in pediatric antidepressant use increased the social costs of substance use, abuse, and dependence (health care use, poor school performance, delinquency, criminal activity). Our analysis will use a regression discontinuity design to compare the prescribing patterns and SUD outcomes of youths with new onset of depression just before and immediately after the 2004 FDA warnings on pediatric antidepressant use.