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Increased Use of Antidepressants by Children

The 3- to 5-fold increase in pediatric antidepressant use over 7 years emphasizes the need for more testing of drugs in children.

In recent decades, large increases have been reported in psychotropic drug use among children. These researchers, who previously investigated psychotropic drug use in preschoolers (Journal Watch Psychiatry Apr 1 2000), have studied pediatric antidepressant use in 2 Medicaid facilities (in Midwest and Midle Atlantic states) and in an HMO in the Northwest from 1988 to 1994 (records of over 800,000 pediatric patients were reviewed for each year). Records were examined for type of antidepressant, age range, and sex; Medicaid records also were examined for type of care (general pediatric vs. psychiatric) and diagnoses.

Over 7 years, the use of antidepressants increased 3- to 5-fold. From ages 10 to 14, boys received more antidepressant prescriptions than did girls; from ages 15 to 19, girls received more antidepressant prescriptions than did boys, except in the Middle Atlantic state Medicaid facility.

In the Medicaid systems, 42% and 72% of patients (Middle Atlantic and Midwest facilities, respectively) were under the care of nonpsychiatric practitioners. Primary care physicians prescribed antidepressants primarily for attention deficit hyperactivity disorder; in contrast, psychiatrists usually prescribed these drugs for depression.

Comment: As the authors note, given the relatively scant data on using antidepressants to treat children, these large increases in use emphasize the need for more research. The federal Best Pharmaceuticals for Children Act, signed into law in January, should enhance future testing of more drugs in the pediatric population. These data also support the need for psychiatric care regardless of economic status, given the large differences in drug prescriptions between primary care providers and psychiatrists.

— Barbara Geller, MD

Published in Journal Watch Psychiatry June 19, 2002

Citation(s):

Zito JM et al. Rising prevalence of antidepressants among US youths. Pediatrics 2002 May; 109:721-7.

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