Psychiatric medications under-prescribed in youth with ADHD and other mental disorders, finds study

Psychiatric medications under-prescribed in youth with ADHD and other mental disorders, finds study

Over the last few years, psychiatric medications have become popular for treating emotional or behavioral difficulties in children and adolescents. Significant increases were previously observed in the prescriptions of anti-stimulants, antidepressants and antipsychotic medicines for children with psychiatric disorders. This led to widespread concerns that instead of being made to undergo therapy, children and adolescents are being over-medicated. A recent study at the Columbia University Irving Medical Center (CUIMC) attempted to challenge this widely held notion.

The findings, published in the Journal of Child and Adolescent Psychopharmacology in January 2018, showed that some of these medications were being under-prescribed. The study estimated that annually, one in eight American teens experienced a depressive episode, and nearly one in 12 children exhibited symptoms of attention deficit hyperactivity disorder (ADHD). During the review period, fewer than one in 30 teens received a prescription for antidepressants, and only one in 20 received a prescription for stimulants. According to lead author Ryan S. Sultan, a child psychiatrist and researcher at the CUIMC, the findings were “inconsistent” with the belief that children and adolescents were being over-medicated.

The study analyzed the annual prescription data for three psychiatric drug categories – antipsychotics, stimulants and antidepressants – for more than 6 million children and young adults aged between 3 and 24 years. The prescribing patterns were compared with known occurrence rates of ADHD, depression and anxiety disorders among young children (3-5 years), older children (6-12 years), adolescents (13-18 years) and young adults (19-24 years). This was the first nationwide study to examine the rates of prescription for these three categories of psychiatric medications in youth.

Consistency in prescribing patterns of antidepressants and stimulants

According to co-author Mark Olfson, a professor of psychiatry at the CUIMC, the study also showed that the prescribing patterns for antidepressants and stimulants among American youth were broadly consistent with the typical ages at which common mental disorders first appeared. However, this was not the case for antipsychotic medications. Due to the “clinical uncertainty over their appropriate indications,” it was unclear if annual prescription rates of antipsychotics – ranging from 0.1 percent in younger children to 1 percent in adolescents – were higher or lower than the rates of the mental disorders they targeted.

The smallest number of prescriptions (0.8 percent) for any psychiatric drug was for children in the youngest age group, while the highest number (7.7 percent) was for adolescents. The number of stimulant prescriptions was the highest in older children (4.6 percent); with male children receiving higher prescriptions compared to females. Antidepressant prescriptions, which increased with age, were the highest for young adults (4.8 percent), especially for females. The adolescent age group had peak antipsychotic prescriptions (1.2 percent), with males accounting for slightly higher prescriptions compared to females.

Continuous assessment of patterns and distribution of psychiatric medication

The researchers acknowledged the need for continuous assessment of patterns and distribution of psychiatric medications given that prescribing patterns may have changed since the study’s data was collected. Improving access to child psychiatrists through counselling services and integrated care models could help in addressing potential under-treatment and also alleviating the risk of suggesting medicines before trying other treatments.

The American Academy of Child and Adolescent Psychiatry (AACAP) also advocated a similar approach. Psychiatric medication should be a component of a comprehensive treatment plan, “with ongoing medical assessment and, in most cases, individual and/or family psychotherapy.” While medication may help in reducing or eliminating symptoms of psychiatric disorders in children, they may also have moderate-to-serious side-effects.

ADHD in children and adolescents

It has been previously estimated that 5 percent children have ADHD, with higher rates estimated in community samples. Nearly 11 percent children aged between 4 and 17 years (6.4 million) had ever been diagnosed with ADHD. In 2003, ADHD diagnosis was 7.8 percent, which increased to 9.5 percent in 2007. In 2011, an estimated 17.5 percent children aged 4-17 with current ADHD were neither receiving medication nor mental health counseling for their condition.

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