Depression Treatment and Substance Abuse

描述（由申请人提供）：患有物质使用障碍（SUD）的人的精神疾病发病率比其他人群高得多。一项为期10年的科摩罗国家调查纵向随访证实，与没有重度抑郁症的个体相比，基线时患有重度抑郁症的个体在随后的十年中发生尼古丁依赖的几率高出40%，开始使用非法药物的几率高出90%。抑郁症和SUD之间的关联打开了一种可能性，即成功治疗儿童抑郁症可以减轻SUD的不良后果，考虑到儿科人群中的一系列循证治疗以及70%的SUD在20岁时首次出现的事实。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，因为很难确定抑郁症是否会导致物质使用，或者是否有第三个因素在抑郁症和SUD之间产生虚假的相关性。为了研究抑郁症治疗如何预防或改变SUD的发生和后果，我们建议利用一个强大的自然实验：美国食品药品监督管理局（FDA）2004年关于儿童使用抗抑郁药相关自杀风险的警告引起的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，导致有记录的抑郁症发病率下降，并使儿童抑郁症患者的抗抑郁药使用减少了20%至30%，使其成为一种罕见而强大的自然实验。此外，在FDA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，这意味着警告深刻影响了抑郁症状。使用三个数据源，共同提供有关物质使用，滥用和依赖，医疗保健利用的信息（包括处方药的数据），以及学术和犯罪相关的结果，拟议的研究旨在：1）检查FDA关于儿科抗抑郁药使用的警告和儿科抗抑郁药使用的伴随下降是否增加了物质使用、滥用和依赖的发作或强度（烟草，酒精，非法药物和处方药的非法使用）; 2）检查FDA关于儿科抗抑郁药使用的警告和儿科抗抑郁药使用的伴随下降是否增加了医疗保健的使用和成本;和3）检查FDA关于儿科抗抑郁药使用的警告和儿科抗抑郁药使用的伴随下降是否增加了药物使用的社会成本，滥用和依赖（使用医疗保健、学习成绩差、少年犯罪、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对儿科抗抑郁药使用的警告之前和之后的青少年新发抑郁症的处方模式和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.