A new study suggests that contrary to popular opinion, psychiatric medications are not overprescribed for American children. In fact, because of limited access to child psychiatrists, researchers worry more about undertreatment and a failure to explore other means of treatments before medications.
Investigators from Columbia University Irving Medical Center (CUIMC) compared prescribing rates with prevalence rates for the most common psychiatric disorders in children, and discovered that some of these medications may be under prescribed.
“Over the last several years, there has been widespread public and professional concern over reports that psychiatric medications are being overprescribed to children and adolescents in the United States,” said Ryan Sultan, M.D., a child psychiatrist and researcher at CUIMC who led the study. “We were interested in better understanding this concern.”
The research findings appear online in the Journal of Child and Adolescent Psychopharmacology.
Investigators used data from a national prescription database of 6.3 million children between the ages of three and twenty-four years. They reviewed the annual prescriptions for three psychiatric drug classes: stimulants, antidepressants, and antipsychotics. They then compared prescribing patterns with known prevalence rates of attention deficit-hyperactivity disorder (ADHD), anxiety disorders, and depression between young children (three to five years), older children (six to 12 years), adolescents (13 to 18 years), and young adults (19 to 24 years).
This is the first national study to analyze prescription rates for these three types of psychiatric medications in youth.
Annually, an estimated one in eight U.S. teenagers has a depressive episode, and roughly one in twelve children have symptoms of ADHD. During the year studied, fewer than one in thirty teenagers received a prescription for antidepressants, and only one in twenty received a prescription for stimulants.
“Our results show that, at a population level, prescriptions of stimulants and antidepressant medications for children and adolescents do not appear to be prescribed at rates higher than the known rates for psychiatric conditions they are designed to treat,” said Sultan. “These findings are inconsistent with the perception that children and adolescents are being overprescribed.”
The overall patterns in psychiatric drug prescription was found to be that children in the youngest group accounted for the smallest number (0.8 percent) of prescriptions for any psychiatric drug, while adolescents accounted for the highest number (7.7 percent).
The number of prescriptions for stimulants was highest in older children (4.6 percent), with males accounting for more of these prescriptions than females. Antidepressant prescriptions increased with age and was highest for young adults (4.8 percent), particularly for females. Antipsychotic prescriptions peaked during adolescence (1.2 percent) and were prescribed slightly more often for males in this age group.
“The study also showed that, among young people in the United States, the patterns of prescriptions for antidepressants and stimulants are broadly consistent with the typical ages associated with the onsets of common mental disorders, said Mark Olfson, M.D., professor of psychiatry at CUIMC and senior author of the paper.
“However, the situation with antipsychotic medications is less clear cut. Given clinical uncertainty over their appropriate indications, it is unclear whether their annual use rates, which ranged from 0.1 percent in younger children to 1 percent in adolescents, are above or below the rates of the psychiatric disorders they aim to treat.”
“These results provide some reassurance to those who are concerned about the overprescribing of psychiatric medications to children and teenagers,” said Sultan.
“Improving access to child psychiatrists through consultation services and collaborative care models may help address potential undertreatment while also reducing the risk of prescribing medications before other treatments have been tried.”
Source: Columbia University/EurekAlert