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Psychotropic medication use not widespread in teens

Monday December 3, 2012
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About 14% of adolescents with any mental disorder reported treatment with a psychotropic medication within the previous 12 months, according to a study.

The researchers suggested the findings challenge concerns about widespread overmedication and misuse of psychotropic medications among young people in the United States.

Concern has been raised about inappropriate prescribing of psychotropic medications to children and adolescents, but these criticisms have been based on anecdotal reports, studies of small, unrepresentative clinical samples and secondary analyses of large databases on prescription drug use that lacked clinical information, the authors wrote in background information for the study, which appeared Dec. 3 on the website of the Archives of Pediatrics & Adolescent Medicine.

The study by Kathleen R. Merikangas, PhD, of the National Institute of Mental Health in Bethesda, Md., and colleagues evaluated the prevalence, demographic and clinical correlates, and specificity of classes of psychotropic medications indicated for mental disorders.

The study involved 10,123 adolescents (ages 13 to 18) who participated in the National Comorbidity Survey Adolescent Supplement between February 2001 and January 2004. Researchers examined mental and neurodevelopmental disorders from the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition.

Among patients with any DSM-IV mental disorder, 14.2% reported having been treated with a psychotropic medication. Adolescents with attention-deficit/hyperactivity disorder had the highest prevalence, at 31%, followed by those with mood disorders (19.3%), behavior disorders (19.3%), substance use disorders (14.4%) and anxiety disorders (11.6%).

Antidepressants were most frequently used among those with primary mood disorders (14.1%); stimulant use was most common among those with ADHD (20.4%); and antipsychotic use was infrequent and mostly seen among those with serious developmental disorders, the researchers reported.

"The results challenge recent concerns over widespread overmedication and misuse of prescribed psychotropic medications in U.S. adolescents," the authors wote. "There was no compelling evidence for either misuse or overuse of psychotropic medications.

"Only 14.2% of youth with a mental disorder during the past year reported psychotropic use, and the majority who had been prescribed medications, particularly those who received treatment in specialty mental health settings, had a mental disorder with severe consequences and impairment, functional impairment, suicidality or associated behavioral and developmental difficulties."

In an accompanying editorial, David Rubin, MD, MSCE, of PolicyLab, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, wrote: "The unfortunate epiphany is that the risk for overprescribing or underprescribing medication is not the same for all children in this country. For many, the challenge of accessing care acts as a natural barrier to prevent excessive medication use, even if those barriers prevent needed treatment for a child.

"To this point, I agree wholeheartedly with [the study authors]. But for other children, principally those in publicly funded systems, advocacy to increase their access to services has opened a whole new can of worms; the system that we will expose them to if they swing through the access gate is ill-prepared to provide them with the appropriate services they need."

The study abstract is available at http://archpedi.jamanetwork.com/article.aspx?articleid=1465762.


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