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Pediatric Treatment with Antipsychotic Drugs
It’s becoming more common, even though sparse data support the trend.
Recently, the increased use of psychotropic drugs by children and adolescents has been documented (see, e.g., Journal Watch Psychiatry Jun 19 2002). To study the trends in pediatric antipsychotic-medication use, all of which is off-label, researchers examined data on individuals ages 0 to 20 years from the National Ambulatory Medical Care Survey in 1993 through 2002 (range of annual physician response rates, 70%–73%). The data included the number of mental health visits involving antipsychotic medication, the type of antipsychotic (typical or second-generation), concomitant medications, patient demographics, and diagnoses.
Over 10 years, there was a sixfold increase in the annualized number of office-based medical visits that included prescription or monitoring of antipsychotic medication. The disorders commonly diagnosed included disruptive behavior (37.8%), mood (31.8%), developmental (17.3%), and psychotic disorders (14.2%). In 2000 through 2002, 92% of these visits were for second-generation drugs. Predictors of the visits in 2000 through 2002 were public insurance (vs. private insurance); white non-Hispanic race; male sex; visit with a psychiatrist; and diagnoses of psychotic disorder, mood disorder, tic disorder, or pervasive developmental disorder or mental retardation. No data were available for dosage, duration of treatment, or the mean number of visits per patient.
Comment: These data clearly document a huge increase in pediatric antipsychotic use; such use is often not supported by evidence from treatment studies. These medications have many side effects (see, e.g., Journal Watch Psychiatry Apr 5 2006), and our knowledge of developmental effects is limited. Physicians and families need to continue to weigh the risks of these drugs against their benefits on a case-by-case basis.
— Barbara Geller, MD
Published in Journal Watch Psychiatry June 21, 2006
Citation(s):
Olfson M et al. National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry 2006 Jun; 63:679-85.
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