Tue Jan 14, 2003 10:25 AM ET

Health - Reuters

Study Shows Surge in Psychiatric Drug Use in Kids

By Suzanne Rostler

NEW YORK (Reuters Health) - About 6% of US children are taking drugs to treat depression, attention deficit/hyperactivity disorder (ADHD) and a host of other behavioral and emotional problems, researchers said Monday.

Their study of data on nearly 900,000 individuals younger than 20 years who were enrolled in an HMO or received Medicaid revealed a 200% to 300% increase in the use of psychotropic drugs between 1987 and 1996, with the greatest increase occurring after 1991.

Alpha-agonists such as clonidine, which is used to treat behavior problems, saw the greatest increase. Prescriptions for neuroleptics, antidepressants and "mood stabilizer" anticonvulsants, which are used to control acting out and violent behavior in kids, also rose during the study.

In general children on Medicaid, the federal health insurance program for the poor, were more likely to be prescribed these drugs than were kids whose families were enrolled in an HMO, and children on Medicaid receiving the drugs tended to be younger than their HMO-enrolled counterparts. For instance, children aged 10-14 years were the largest users of psychotropic drugs among Medicaid recipients, compared with children aged 15-19 years in the HMO group.

Males were more likely than females to be prescribed psychotropic drugs overall, particularly if they received Medicaid, according to the report in the January issue of the Archives of Pediatric and Adolescent Medicine.

It is not clear from the study why the use of psychotropic drugs rose so dramatically among children, or why there are different patterns of use among children insured through an HMO and through Medicaid.

In an interview with Reuters Health, Dr. Julie Magno Zito, the study's lead author, said that changes in diagnosis, access to medical treatment and a greater awareness of the mental health treatment needs of youths may explain the results. Greater visibility of drug promotion may also play a role, according to Zito, of the University of Maryland, Baltimore.

In an accompanying editorial a doctor from Massachusetts General Hospital in Boston said that the data may reflect higher rates of mental illness among Medicaid users, who are generally less well-off than those who use employer-based insurance. Alternatively, a greater awareness of psychiatric disorders and better drugs may have led to more prescriptions, suggests Dr. Michael S. Jellinek.

However, he notes that usage of many drugs increased in youngsters despite little research on their effectiveness in children.

"Given the scale of current psychotropic medication utilization, we have a responsibility to know what we are doing and the quality of our efforts," Jellinek writes. "We need to ask the mirror on the wall this question: Are we prescribing the right psychotropic medications to the right children using the right treatment plan?"

The study authors conclude that more research is needed to update the current report and to examine trends for specific drugs. A more nationally representative group of children might also better reflect trends, they suggest.

SOURCE: Archives of Pediatric and Adolescent Medicine 2003;157:17-25.

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