In the Journals

Some psychiatric medications may be underprescribed for youth

After comparing prescribing rates of stimulant, antidepressant and antipsychotic medications for children and young adults with prevalence rates of ADHD, depression and anxiety, researchers found that psychiatric medications are not actually overprescribed to youth, contrary to popular beliefs, according to study results.

“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,” Ryan S. Sultan, MD, from the department of psychiatry in the College of Physicians and Surgeons of New York State Psychiatric Institute at Columbia University, said in a press release. “We were interested in better understanding this concern.”

Using data on national prescribing claims from all payment sources, researchers examined the national annual prescribing patterns of stimulant, antidepressant and antipsychotic medications given to children and young adults. They categorized 6.3 million youth by sex and age group: younger children aged 3 to 5 years, older children aged 6 to 12 years, adolescents aged 13 to 18 years and young adults aged 19 to 24 years. Performing this analysis in an age-related context enabled the investigators to examine the extent to which national pharmacological treatment patterns map onto known national epidemiologic prevalence rates of three mental disorders — ADHD, anxiety disorders and depression — common among young people.

Sultan and colleagues found that the patterns of filled prescriptions for antidepressants and stimulants that treat young people in the U.S. are consistent with onsets of the common mental disorders from early childhood to young adulthood; however, the percentages of youth prescribed these medications were lower than the known prevalence of the corresponding disorders.

“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,” Sultan said in the release. “These findings are inconsistent with the perception that children and adolescents are being overprescribed.”

Projecting the annual percentage of prescriptions filled by young people in this cohort to the national population, they would represent about 0.8% of young children, 5.4% of older children, 7.7% of teenagers and 6% of young adults who took medication for ADHD, anxiety or depression. Analysis showed that antidepressant use often increased with age and was highest for young adults aged 24years (4.8%), whereas stimulant use was highest for older children aged 11 years (5.7%). Annual antipsychotic prescription percentages were lower than antidepressant or stimulant percentages, with a peak observed in adolescence at age 16 years (1.3%). Overall, more males than females received stimulants and antipsychotics, but this finding converged for young adults. Psychiatrists and child psychiatrists were usually responsible for prescribed antidepressants (22.2%-53.2%) and antipsychotics (51.7%-70%), but not typically for the stimulant prescriptions (30.4%-36.2%).

“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,” Sultan said. “Acknowledging that prescription patterns may have changed since the data were collected, it is important to continue to assess the pattern and distribution of psychiatric medications to children and adolescents in the U.S.” – by Savannah Demko

Disclosures: Sultan reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

After comparing prescribing rates of stimulant, antidepressant and antipsychotic medications for children and young adults with prevalence rates of ADHD, depression and anxiety, researchers found that psychiatric medications are not actually overprescribed to youth, contrary to popular beliefs, according to study results.

“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,” Ryan S. Sultan, MD, from the department of psychiatry in the College of Physicians and Surgeons of New York State Psychiatric Institute at Columbia University, said in a press release. “We were interested in better understanding this concern.”

Using data on national prescribing claims from all payment sources, researchers examined the national annual prescribing patterns of stimulant, antidepressant and antipsychotic medications given to children and young adults. They categorized 6.3 million youth by sex and age group: younger children aged 3 to 5 years, older children aged 6 to 12 years, adolescents aged 13 to 18 years and young adults aged 19 to 24 years. Performing this analysis in an age-related context enabled the investigators to examine the extent to which national pharmacological treatment patterns map onto known national epidemiologic prevalence rates of three mental disorders — ADHD, anxiety disorders and depression — common among young people.

Sultan and colleagues found that the patterns of filled prescriptions for antidepressants and stimulants that treat young people in the U.S. are consistent with onsets of the common mental disorders from early childhood to young adulthood; however, the percentages of youth prescribed these medications were lower than the known prevalence of the corresponding disorders.

“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,” Sultan said in the release. “These findings are inconsistent with the perception that children and adolescents are being overprescribed.”

Projecting the annual percentage of prescriptions filled by young people in this cohort to the national population, they would represent about 0.8% of young children, 5.4% of older children, 7.7% of teenagers and 6% of young adults who took medication for ADHD, anxiety or depression. Analysis showed that antidepressant use often increased with age and was highest for young adults aged 24years (4.8%), whereas stimulant use was highest for older children aged 11 years (5.7%). Annual antipsychotic prescription percentages were lower than antidepressant or stimulant percentages, with a peak observed in adolescence at age 16 years (1.3%). Overall, more males than females received stimulants and antipsychotics, but this finding converged for young adults. Psychiatrists and child psychiatrists were usually responsible for prescribed antidepressants (22.2%-53.2%) and antipsychotics (51.7%-70%), but not typically for the stimulant prescriptions (30.4%-36.2%).

“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,” Sultan said. “Acknowledging that prescription patterns may have changed since the data were collected, it is important to continue to assess the pattern and distribution of psychiatric medications to children and adolescents in the U.S.” – by Savannah Demko

Disclosures: Sultan reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.