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Psychiatric drug use in preschoolers stabilizing

By Andrew M. Seaman

NEW YORK (Reuters Health) - By the end of the last decade, psychiatric medications were being used less often in very young children, a new study suggests.

Researchers found the percentage of children prescribed antipsychotics, stimulants and antidepressants at doctors' visits spiked in the mid-2000s but leveled off again between 2006 and 2009.

"I'm very excited that the use of these drugs in this age group seems to be stabilizing," Dr. Tanya Froehlich, the study's senior author from Cincinnati Children's Hospital Medical Center in Ohio, told Reuters Health.

"It's good to get a gauge on what we're doing with psychotropic medications in this age group, because we really don't know what these medications do to the developing brain," she said.

Previous studies have tried to estimate the use of psychiatric, or psychotropic, drugs among preschoolers, Froehlich and her colleagues write in Pediatrics. But those studies tended to focus on one class of medication or only a segment of the population.

For the new study, the researchers pulled national data from 1994 to 2009 on about 43,500 doctors' visits for kids aged two to five.

During that time, the proportion of psychotropic drug prescriptions varied between one prescription for every 217 doctors' visits in 1998 and one for every 54 visits in 2004.

Overall, the researchers found about 1.0 percent of preschoolers left doctors' visits with a psychotropic prescription between 1994 and 1997. That rate fell to about 0.8 percent between 1998 and 2001. It then jumped to a high of about 1.5 percent between 2002 and 2005 and then returned to 1.0 percent between 2006 and 2009.

The decrease and stabilization in the most recent years occurred even though more children were being diagnosed with behavioral disorders throughout the study period.

Although the study can't explain why the rate of prescriptions dropped in 2006 to 2009, the researchers suggest it may be due to an increased awareness of possible side effects from these types of medications.

For example, the U.S. Food and Drug Administration issued a strong warning in 2004 about a link between antidepressant use among children and suicide risk.

A number of conditions, including diabetes and obesity, have also been linked to the use of antipsychotics among children (see Reuters Health story of August 22, 2013 here: http://reut.rs/1awjd3t.)

"I think this is an area that has gotten a fair amount of public attention and it could be this is parents and physicians stepping back from a willingness to prescribe these medications," Dr. Mark Olfson, who was not involved with the study but has researched medication use among children, said.

"Mostly they're being prescribed to bring various kinds of disruptive behavior in preschoolers under control. I hope (these findings suggest) parents are searching for other means to address this behavior," Olfson, a professor of clinical psychiatry at Columbia University Medical Center in New York, told Reuters Health.

"The thing pediatricians should be asking themselves is, ‘Are we really following the guidelines in treating these children?' which is trying behavioral therapy and then going to the medications," Froehlich said.

"What really is important is that a thorough assessment be conducted before any decision is made about prescribing medications," Olfson added.

SOURCE: http://bit.ly/HjQ8dI Pediatrics, online September 30, 2013.

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