Tweet

College of Physicians & Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY

First published in Psychiatry Weekly, Volume 8, Issue 9, April 22, 2013

Introduction

A number of reports in recent years confirm that psychopharmacological treatment is growing among young people in the US, particularly among the antidepressant and stimulant classes. According to Dr. Mark Olfson, many of those studies rely on insurance claims information, pharmacy records, or physician surveys, which may only tell half the story.

“What’s largely missing from the literature is a systematic assessment of the clinical symptoms and DSM diagnoses of young people who are receiving antidepressants and stimulant medications,” says Dr. Olfson. “Without this information, it is not possible to evaluate the extent to which prescribing practices match the underlying psychopathology.”

Psychotropic Use By Adolescents

Using data from a large, nationally representative cohort (n=10,123), Dr. Olfson and colleagues analyzed psychotropic use patterns and underlying psychopathology in American adolescents aged 13–17 years. Respondents reported any treatment—including psychopharmacological treatment—for emotional or behavioral problems during the previous 12 months, and were administered a modified version of the World Health Organization’s Composite International Diagnostic Interview (CIDI).

In terms of overall rates of psychotropic use, 7% of adolescents had received a psychotropic medication during the previous 12 months, of which 74% had at least one 12-month DSM-IV disorder; the three most common types were mood disorders, disruptive behaviors, and anxiety disorders.

The five most commonly represented classes of psychotropics in this study included antidepressants (3.9%), stimulants (2.8%), anxiolytics (0.8%), mood stabilizers (0.4%), and antipsychotics (0.5%).

“Only some of the adolescents in this study who were receiving a given class of psychotropic medication currently or previously met criteria for a DSM disorder for which that medication class is known to be efficacious,” says Dr. Olfson. “For example, of the adolescents who said they used antidepressants during the past year, about half of them had a recent DSM-IV mood or anxiety disorder. There were also a number of adolescents receiving antidepressants who had no history of a depressive or anxiety disorder but met criteria for ADHD, instead. Such misalignments between medications and symptoms suggest that there’s still room for improvement in matching prescribed medications to actual underlying disorders.”

An important limitation of this study concerns when the data were collected, between 2002–2004.

“One can argue—and studies conducted since this period suggest—that there has been an increase in the treatment of adolescents with antidepressants and stimulants,” says Dr. Olfson. “The new analysis provides a picture of psychotropic prescribing practices for American adolescents a decade ago. The adolescents were sampled and the data are weighted in such a way that makes the results nationally representative. As a result, the findings are more meaningful than had the survey been based on an unweighted convenience sample of young people.”

Conclusion

“I think this is one of the few studies that provide clinically reliable information about potential problems with overprescription of antidepressants and stimulants to adolescents,” continues Dr. Olfson. “By looking at the clinical characteristics of adolescents who actually receive psychotropic medications, these findings offer a means of evaluating possible overprescription. The results suggest that there is still room for improvement in terms of aligning treatments with actual underlying disorders, but the findings also suggest that community prescribing practices aren’t as out of line as many had previously assumed.”

Disclosure: This work was supported by Intramural Research Program of the NIMH (Grant #Z01 MH002808-08); the NCS-A and NCS surveys are supported by the NIMH (Grant #U01-MH60220).

This interview was conducted on January 16, 2013 by Lonnie Stoltzfoos

Reference:

1. Olfson M, He J, Merikangas KR. Psychotropic medication treatment of adolescents: results from the National Comorbidity Survey-Adolescent Supplement. J Am Acad Child Adolesc Psychiatry. 2013;52:378-388.

 Tweet