Psychiatric drug use in young is exploding

By Dorsey Griffith -- Sacramento Bee Medical Writer

January 14, 2003

Children and adolescents are taking all kinds of psychiatric medications at nearly the same rate as adults, despite the relative lack of knowledge about how they are used and how well they work in younger age groups, according to a study released today.

Between 1987 and 1996, the numbers of children receiving psychotropic medication of all types increased two-to threefold, with the most rapid increase since 1991, according to the study published in the Archives of Pediatric and Adolescent Medicine.

Overall, about 6 percent of youths younger than 20 are being treated with one or more drugs including stimulants, antidepressants, anti-psychotics or mood stabilizers.

The study findings are consistent with those gleaned from a Bee analysis of national drug data published in June. That data, based on the number of times certain drugs are provided, prescribed or refilled during patient visits with doctors, showed dramatic increases in all classes of psychiatric medications between 1995 and 2000.

The findings suggest an increasing reliance on drugs to address childhood behavior and mental health problems and spotlight the need to know the long-term impact of that, concluded Julie Magno Zito, a professor of pharmacy and medicine at the University of Maryland, and the lead investigator.

"There isn't adequate study at all of the question of drug safety," Zito said. "What are the long-term exposures going to mean?"

She said more trials are needed to determine whether drug treatment is cost effective or even more effective than behavioral interventions.

In an accompanying editorial, Michael Jellinek, chief of child psychiatry at Massachusetts General Hospital and a Harvard Medical School professor, said the higher drug treatment rate is a result of health care systems that limit a patient's access to more comprehensive care -- including the use of non-drug therapy and other services.

"Probably most kids are getting meds for a reasonable reason, but there may be some that are getting it inappropriately or that need other services or maybe are misdiagnosed because they have no access to a child psychiatrist," he said in a telephone interview Monday.

He called on the health insurance industry to provide the data to determine whether drug treatment has been effective in children. "I don't want to blame the parent or the doctor," he said.

In the most extensive study of its kind, Zito examined the treatment data of nearly 900,000 young people enrolled in Medicaid in two states and in one nonprofit HMO in the Northwest.

The study employed the same data Zito used to highlight the increasing use of psychiatric drugs in preschool age children for whom such medications have not been approved by the Food and Drug Administration. That study, published in the Journal of the American Medical Association in 2000, prompted the federal government to launch a major study to determine the safety and effectiveness of stimulants in young children with attention deficit hyperactivity disorder -- the most common psychiatric diagnosis in children.

In her current analysis, Zito found that stimulants such as Ritalin were the most widely prescribed psychiatric drugs in children, followed by antidepressants such as Prozac and mood stabilizing medications such as Depakote used to treat bipolar disorder.

The research found that the use of neuroleptics, also known as anti-psychotics, also is on the rise. Zito said that cannot be attributed to a corresponding jump in psychotic disorders such as schizophrenia in children.

Instead, Zito assumes they are being used increasingly to treat aggressive or violent children.

Dr. Joseph Sison, medical director for Sacramento County Children's Mental Health and a professor at the UC Davis Department of Psychiatry, agreed that more and more physicians are turning to mood stabilizers and anti-psychotics for behavior problems when nothing else seems to work.

"You have a kid who has ADHD or bipolar disorder or oppositional defiant disorder, and they are getting worse, and they have had psychotherapy, and nothing has worked," he said. "What do you do?"

Sison said that in his experience, about 70 percent of children who are at risk of being kicked out of school, home or foster care because of their behavior will stabilize with the use of these medications, particularly the newer drugs that carry fewer side effects than older classes of psychiatric medications.

In addition, failure to treat increasingly troubled children can have dire consequences including academic failure and substance abuse, said Dr. Penelope Knapp, medical director for children's services at the State Department of Mental Health and a child psychiatrist at UC Davis.

"There are great costs of not treating children when it is indicated," she said. "As people are recognizing that, they are less timid about writing a prescription. Some of the increase in prescriptions by child psychiatrists reflects progress."