Blue Cross Blue Shield of Georgia Protects Children and Adolescents on Antidepressants Through New Physician Notification Program.

ATLANTA -- On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory regarding the possible worsening of depression and suicidal thoughts in adults and children taking antidepressant medications. Based in part upon studies of antidepressants in children and adolescents, the advisory recommended the close monitoring of all patients either starting on or undergoing a dosage change for antidepressants. This advisory has created an increased level of concern in patients taking these medications, especially the parents of children and adolescents. In response, Blue Cross Blue Shield of Georgia (BCBSGa) today announced a new program that provides network physicians with the FDA advisory and gives them a list of their children and adolescent patients (18 years old and younger) covered through a health benefit plan offered by BCBSGa for whom they have prescribed an antidepressant in the last six months. BCBSGa's Antidepressant Physician Notification Program is designed to provide physicians with clear information on how to integrate the FDA advisory into their medical practice.

The Surgeon General's Report on Mental Health in 1999 emphasized that depression and suicide are serious problems facing our youth. "BCBSGa's Antidepressant Notification Program helps to ensure that our physician partners have the information they need to make both good decisions and also to educate their patients," said Dr. Michael Brase, vice president and medical director for behavioral health services for the company. "We hope that providing the full FDA advisory will allow a thoughtful approach that balances the risk of medication with the need for treatment and allows doctors and members to know and consider all their options for treating children, including psychotherapy. "BCBSGa is available to assist in referrals to therapists and child psychiatrists and also offers a physician helpline."

"Providing physicians with patient specific information as well as the supporting FDA information allows a good clinical decision to be made by the member's physician," said Dr. Louise Short, BCBSGa vice president and corporate medical director. "Our Antidepressant Notification Program is one of the most comprehensive approaches we've seen in support of the FDA advisory and supports our own corporate goal of engaging our network physicians as 'trusted partners'."

The physician mailing, sent recently, included a copy of the FDA Public Health Advisory; a copy of the FDA's Questions and Answers on Antidepressant Use in Children, Adolescents, and Adults; a member specific list, and a cover letter. The letter suggests the physician review the indication for the antidepressant medication, and talk with the patient and their family. In many cases the physician's clinical judgment may be that continued antidepressant treatment is appropriate for the child or adolescent.

BCBSGa has also provided network physicians with a list of possible talking points to use when speaking to the parents of children receiving antidepressant treatment, which include:

--If a child is already on medication, it may be unwise to discontinue it, especially if his or her mood has improved; the depressive symptoms may worsen and discontinuation symptoms may occur if the medication is abruptly stopped.

--Encourage parents to discuss their concerns about medication with you (the physician) and not discontinue medication without your advice and guidance.

--If discussing the initiation of antidepressant medication, inform the parents of other treatment options such as psychotherapy and/or referral to a child psychiatrist for a second opinion.

--It will be important for the child to be seen frequently when antidepressants are first started and while the dose is being adjusted. Keeping appointments is important.

--Encourage parents to talk to their children about the medication and why they are taking it so the child/adolescent knows to report any side effects and also if they are experiencing a worsening of their depression.

Blue Cross Blue Shield of Georgia, serving more than 3.1 million medical members, is the oldest and largest health benefits company in Georgia. Blue Cross Blue Shield of Georgia is an operating subsidiary of WellPoint Health Networks Inc., the nation's second largest publicly traded health care company serving the health care needs of 15.5 million medical members and 46.2 million specialty members nationally. WellPoint offers a broad spectrum of quality network-based health products including open access PPO, POS and hybrid products, HMO and specialty products. Specialty products include pharmacy benefit management, dental, utilization management, vision, mental health, life and disability insurance, long term care insurance, flexible spending accounts, COBRA administration, and Medicare supplements. Blue Cross Blue Shield of Georgia can be found on the web at www.bcbsga.com. Blue Cross Blue Shield of Georgia is an independent licensee of the Blue Cross and Blue Shield Association.