This is the first national study to analyze prescription rates of ADHD, anxiety disorders and depression psychiatric medications in youth.
Ryan Sultan, MD
A new study at Columbia University Irving Medical Center challenges the popular notion that psychiatric medications are overprescribed in children and adolescents in the US.
Published in the Journal of Child and Adolescent Psychopharmacology, researchers compared prescribing rates with prevalence rates for the most common psychiatric disorders in children.
“Accurate prescribing of psychiatric medications to youth can be a challenging,” Ryan Sultan, MD, child psychiatrist and clinical researcher in the areas of Schizophrenia, Anxiety, Depression and ADHD at Columbia University Medical Center, said to MD Magazine. “When pediatricians or family practitioners are unsure or feel out of their comfort zone, they should strongly consider referring for consultation to a child psychiatrist.”
Researchers pulled data from a national prescription database to look at annual prescriptions for 3 psychiatric drug classes: stimulants, antidepressants and antipsychotics for 6.3 million children between the ages of 3—24 years.
Prescribing patterns were compared with known prevalence rates of attention deficit-hyperactivity (ADHD), anxiety disorders and depression between young children (3—5 years), older children (6–12 years) adolescents (13–18 years) and young adults (19–24 years).
The total annual percentage of prescriptions filled by youth for any of the 3 medication classes was by age: 3—5 years (0.8%), 6–12 years (5.4%), 13–18 years (7.7%) and 19–24 years (6%).
Stimulant use was highest for older children at age 11 (5.7%), while antidepressant use tended to increase with age and was highest for adults age 24 (4.8%).
The findings indicated annual stimulant and antipsychotic percentage for males were higher than corresponding percentage for females but intersected for young adults.
In terms of prescribing medication, psychiatrists and child psychiatrists accounted for most antidepressant prescriptions (22.2%—53.2%) and antipsychotics (51.7%–70%) but fewer stimulant prescriptions (30.4%–36.2%).
"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 patterns of filled prescriptions for antidepressants and stimulants are broadly consistent with developmental onsets of the common mental disorders from early childhood to young adulthood," the researchers said. "However, the percentages of young people prescribed stimulant and antidepressant medications were lower than the known prevalence of corresponding disorders, and the demographic pattern of antipsychotic prescribing likely represents the heterogeneity of conditions treated with this class of medications."
An estimated 1 in 8 US teenagers endure a depressive episode while roughly 1 in 12 children display symptoms of ADHD annually.
During the study years, fewer than 1 in 30 teens received a prescription for antidepressants and 1 in 20 were prescribed stimulants.
“It is important for physicians to complete a through diagnostic assessment before starting a new psychiatric medication. This assessment should include a thoughtful and balanced discussion about the risks and benefits of prescribing a medication versus the risks and benefits of not prescribing," Sultan added. "This conversation is of paramount importance as there are risks to not treating youth."
As physicians work to improve access to child psychiatrists through consultation services and collaborative care models, it may help address potential undertreatment while reducing unnecessary medication prescribing medications. While prescription patterns may have changed since the study was conducted, researchers need to monitor psychotropic medication prescriptions over time to assess patterns and distribution of psychiatric medications.
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