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F I S C A L I M P A C T R E P O R T

SPONSOR

Carraro

ORIGINAL DATE

LAST UPDATED

01/29/08

02/09/08 HB

SHORT TITLE

Study Antidepressants and Suicide

SM 9/aSFL#1

ANALYST Hanika-Ortiz

ESTIMATED ADDITIONAL OPERATING BUDGET IMPACT (dollars in thousands)

FY08

FY09

FY10 3 Year

Total Cost

Recurring

or Non-Rec

Fund

Affected

Total

$0.1

Recurring General

Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Health Policy Commission (HPC)

Regulation and Licensing Department (RLD)

SUMMARY

Synopsis of SFL Amendment # 1

The Senate Floor Amendment # 1 removes the requirement that the task force examine (1)

allowing the prescribing of antidepressants only in conjunction with concurrent psychotherapy;

and, (2) allowing only providers who specialize in psychiatric practice to prescribe psychotropic

medications.

Synopsis of Original Bill

Senate Memorial 9 requests the Health Policy Commission convene an expert task force to study

the correlation between antidepressant use and suicidal thoughts and behaviors and to

recommend solutions to address any correlation.

If a correlation exists, the task force will further examine; (1) mandatory continuing medical

education courses for providers who treat and prescribe for depression in the young; (2) allowing

the prescribing of antidepressants only in conjunction with concurrent psychotherapy; and (3)

allowing only providers who specialize in psychiatric practice to prescribe psychotropic

medications.

Senate Memorial 9/aSFL#1 – Page

2

FISCAL IMPLICATIONS

This study or investigation could become very costly to conduct and there is no appropriation

identified to support this effort. The task force will be required to bring in experts from many

different backgrounds, including the national research community, to provide expertise on

whether a correlation exists and provide recommendations for best practice in the area of

antidepressant pharmaceutical use in children and adolescents.

Agencies will have expenditures in providing staff time to support the task force.

SIGNIFICANT ISSUES

The literature on the link between antidepressant use in children, and suicides and/or suicidal

behavior is inconsistent as to whether there is a link.

DOH reports that debate continues at the national level as to the effectiveness of prescription

antidepressant use in adolescents. The Federal Food and Drug Administration has issued public

warning on the increased risk of suicidal thoughts in adolescents treated with a particular class of

antidepressants called selective serotonin reuptake inhibitors (SSRIs). However, the medical

profession, including the American Psychiatric Association, has conducted numerous studies that

have not found a correlation between the use of SSRIs and suicidal thoughts.

DOH further reports that guidelines for adolescent depression in primary care were recently

published in Pediatrics, Vol.120, No.5, November 2007 that serve to inform the issues presented

in SM 9. In that issue, it was reported that prescriptions of antidepressants for children and

adolescents decreased by 19% in the third quarter of 2004 and 16% in the fourth quarter

compared with the year before. Concern has been expressed that this reduction of

antidepressants prescribed may be related to the 18.2% increase in US youth suicides (from 1737

to 1935) from 2003 to 2004 after a decade of steady declines.

PERFORMANCE IMPLICATIONS

The FDA does require specialized training for certain drugs. The prescribing of antidepressants

isn’t currently one of them.

ADMINISTRATIVE IMPLICATIONS

The HPC will be responsible for administrative support and oversight of task force meetings to

ensure the resolutions in the Memorial are met in a timely manner. In addition, the HPC will be

responsible for ensuring a full complement of health policy experts to participate on the task

force; and, produce, distribute and maintain task force reports.

TECHNICAL ISSUES

Page 1, line 13 after the word “behaviors" in the title, add “in children and adolescents" if that is

the true intent of the Memorial.

Senate Memorial 9/aSFL#1 – Page

3

CONFLICT, DUPLICATION, COMPANIONSHIP, RELATIONSHIP

SM9 relates to HB30, which appropriates $100 thousand to DOH to implement a Native

American, youth-led, peer-to-peer suicide prevention program in McKinley and San Juan

counties.

OTHER SUBSTANTIVE ISSUES

DOH and HPC report that New Mexico prevalence of attempted suicide by adolescents was the

third highest among the states and was 1.5 times the national rate of 8.3%. In addition, 28.7% of

high school students reported persistent feelings of sadness and hopelessness, 20.5% had made a

suicide plan, and 12.5% have attempted suicide. Suicide rates are also highest among Native

American and Hispanic youth in New Mexico with 21% of Native American youth in grades 9-

12 attempting suicide.

ALTERNATIVES

The Federal Drug Administration will continue to make the determination for special training or

labeling requirements necessary for pharmaceuticals with severe side effects.

AHO/mt