January 30, 2018
A new study at Columbia University Irving Medical Center (CUIMC) challenges the popular notion that psychiatric medications are overprescribed in children and adolescents in the U.S. When the researchers compared prescribing rates with prevalence rates for the most common psychiatric disorders in children, they discovered that some of these medications may be underprescribed.
The findings were published online today in the Journal of Child and Adolescent Psychopharmacology.
"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 Sultan, MD, a child psychiatrist and researcher at CUIMC who led the study. "We were interested in better understanding this concern."
How the study was done
Using data from a national prescription database, the researchers looked at annual prescriptions for three psychiatric drug classes-stimulants, antidepressants, and antipsychotics-for 6.3 million children between the ages of 3 and 24 years. They then compared prescribing patterns with known prevalence rates of attention deficit-hyperactivity disorder (ADHD), anxiety disorders, and depression between young children (3 to 5 years), older children (6 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 1 in 8 U.S. teenagers has a depressive episode, and roughly 1 in 12 children have symptoms of ADHD. During the year studied, fewer than 1 in 30 teenagers received a prescription for antidepressants, and only 1 in 20 got 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 Dr. Sultan. "These findings are inconsistent with the perception that children and adolescents are being overprescribed."
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Overall psychiatric drug prescription patterns in children and adolescents Children in the youngest group accounted for the smallest number (0.8 percent) of prescriptions for any psychiatric drug. 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, MD, 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 Dr. 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. Acknowledging that prescription patterns may have changed since the data was collected, it is important to continue to assess the pattern and distribution of psychiatric medications to children and adolescents in the U.S."
