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Kids' psychotropic use approaching adult levels. (Steady Rise Over a Decade).

Children were two to three times as likely to be taking psychotropic medication in 1996 as they were a decade earlier, and those utilization rates were approaching those of adults, according to a 10-year prospective study.

Julie Magno Zito, Ph.D., of the University of Maryland, Baltimore, and her colleagues found that children on Medicaid were more likely to be on psychotropic drugs than those covered by a health maintenance organization (HMO). The study also found that increases were especially marked for antidepressants, anticonvulsants, [alpha]-agonists, and stimulants (Arch. Pediatr. Adolesc. Med. 157[1]:17-25, 2003).

In an editorial accompanying the article, Dr. Michael S. Jellinek of the department of psychiatry at Massachusetts General Hospital, Boston, said physicians must question whether they are prescribing the right kinds of psychotropic drugs to children, and with the proper treatment plans.

The data in Dr. Zito's study, he said, "are a reflection, an imperfect mirror, of the scientific, clinical, financial, and systems changes that affected the care of children between 1987 and 1996 and continue to be a substantial influence" (Arch. Pediatr. Adolesc. Med. 157[1]: 14-16, 2003).

Dr. Jellinek speculated that increased treatment of attention-deficit hyperactivity disorder, the availability of longer-lasting stimulants, and a better understanding of how to use psychotropic drugs to treat depression, schizophrenia, and bipolar disorders in adolescents had a positive effect at least on some of the increases. But Dr. Jellinek said some of the other trends remain troubling.

Specifically, the study found that stimulant use among 5- to 9-year-olds and 10- to 14-year-olds remained constant, indicating little change in the condition of those children. Boys were treated for depression proportionately more than girls. And Dr. Jellinkek wondered whether lower Medicaid reimbursement rates for nonpsychotropic treatments are leading to overuse of drugs in some cases.

In the decade ending in 1996, overall psychotropic drug use tripled, to 5.9% for the children enrolled in an HMO and 6.3% for those enrolled in Medicaid in a Midwestern state. The rate among Medicare patients in the mid-Atlantic state in the study doubled, to 6.2%.

The study looked at psychotropic medication prevalence among nearly 900,000 young people from birth through age 19. More than 75% of those in the study sample were enrolled in Medicaid in two unspecified states--one in the Midwest and one in the mid-Atlantic region--using the states' fee-for-service reimbursement claims for psychotropic prescription drugs. The HMO data were culled from an unspecified provider serving a predominantly employed population in the northwestern United States.

Among specific medications, the most significant increases over the 10 years were with antidepressants, anticonvulsants, [alpha]-agonists, and stimulants.

Antidepressant use climbed from 1.9 per 1,000 youths in 1987 to 20.5 per 1,000 in 1996 in the mid-Atlantic state, from 5.6 to 20.4 in the Midwestern state, and from 2.7 to 16.6 in the HMO.

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Article Details
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Author:Perlstein, Steve
Publication:Clinical Psychiatry News
Article Type:Brief Article
Geographic Code:1USA
Date:Feb 1, 2003
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