Antipsychotic prescriptions for people aged 20 and younger rose sixfold from 1993-2002.
Mark Olfson, MD, MPH, and colleagues report that news in June’s issue of the Archives of General Psychiatry. Olfson works in New York at Columbia University’s psychiatry department.
Most of those prescriptions were for second-generation antipsychotic drugs -- such as Clozaril, Risperdal, Zyprexa, and Seroquel -- which the FDA hasn’t approved for pediatric use, Olfson’s team notes.
“There has been a sharp national increase in antipsychotic treatment among children and adolescents in office-based practices,” write Olfson and colleagues.
“Second-generation antipsychotics are being widely prescribed, and emerging empirical evidence provides a base of support that is limited to short-term safety and efficacy,” the researchers add.
Then and Now
Data came from the National Ambulatory Medical Care Surveys. The numbers only include office-based visits, not visits to community mental health centers or outpatient clinics.
According to the study, there were about 201,000 office-based visits for youths aged 20 and younger that involved antipsychotic treatment in 1993. That number rose to 1,224,000 in 2002.
Other findings include:
Males were more likely than females to get antipsychotic treatment. Antipsychotic treatment was more common for whites than other racial or ethnic groups. Most antipsychotic drugs prescribed in 2000-2002 were second-generation antipsychotic medicines (about 92%).
The surveys also covered six broad, diagnostic categories.
--Disruptive behavior disorders, which include attention deficit hyperactivity disorder (ADHD) -- accounted for the biggest share of the antipsychotic treatments noted in the survey (nearly 38 percent).
--Mood disorders, including bipolar disorder and depression -- came in second, accounting for about 32 percent of the antipsychotic treatments noted in the survey.
--Psychotic disorders, including schizophrenia -- accounted for 14 percent of the antipsychotic treatments seen in the survey.
The rest of the antipsychotic treatments were linked to pervasive developmental disorders or mental retardation.
“In addition, approximately one-third of antipsychotic visits included co-prescription of an antidepressant medication and one-third included co-prescription of a mood stabilizer, the researchers write. They note “a dearth of empirical evidence to support these prescribing patterns.”
The data used in Olfson’s study focused on office visits, not patients. It’s not known if some patients were counted more than once due to multiple office visits.
Doses and length of treatment with antipsychotic medicines weren’t covered, either. Nor were side effects or effectiveness.
Still, the researchers write that “in recent years, second-generation antipsychotic medications have become common in the office-based mental health treatment of young people.”
What accounts for that trend? Olfson’s study doesn’t answer that question. Reasons might include limited opportunities for inpatient care and improvements over earlier antipsychotic drugs, note Olfson and colleagues.
More Research Needed
Second-generation antipsychotic drugs “may be effective for treatment of a variety of different child and adolescent mental disorders,” the researchers write.
But they also mention “tension” between medication patterns and scientific data when it comes to kids’ antipsychotic use.
“In light of the growing and widespread use of these medications, there is a pressing need to increase and extend the experimental evaluation of these medications in children and adolescents,” write Olfson and colleagues.
In the journal, Olfson discloses that he has received grants and/or consulted for the drug companies Eli Lilly, Bristol-Myers Squibb, Pfizer, and McNeil Pharmaceuticals. All four companies are WebMD sponsors.
By Miranda Hitti, reviewed by Louise Chang, MD
SOURCES: Olfson, M. Archives of General Psychiatry, June 2006; vol 63: pp 679-685. News release, JAMA/Archives.