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Ryan S. Sultan, Christoph U. Correll, Michael Schoenbaum | Journal of Child and Adolescent Psychopharmacology | (2018)
Primary Link Archive Pubmed DOI Openalex

Key Takeaways

Plain English Takeaway

Many children, teens, and young adults in the U.S. are prescribed medicines for mental health, and the types of medicines given often match the age and needs of the young people.

Study Aim

The main goal of this study is to describe how often three types of mental health medicines—stimulants (which increase alertness), antidepressants (which treat depression and anxiety), and antipsychotics (which help manage symptoms like hallucinations)—are prescribed to young people in the United States each year. The authors want to see how these prescriptions vary by age, gender, and the type of doctor who writes them. Simply put: The study wants to find out how often and to whom these mental health medicines are given in the U.S.

Study Design

The researchers analyzed prescription data from the IMS LifeLink LRx National Longitudinal Prescription database, which included over 6.3 million young people aged 3 to 24 years. They adjusted the data to better represent the entire U.S. population. The study looked at how many people filled at least one prescription for stimulants, antidepressants, or antipsychotics in a year. The results were broken down by age group, gender, and the specialty of the doctor who prescribed the medicine. Simply put: The study looked at millions of prescription records to see which young people got these medicines and who prescribed them.

Findings

The study reveals that the percentage of young people filling prescriptions for these medicines increases with age, peaking in adolescence and young adulthood. Stimulant use is most common in older children, especially around age 11. Antidepressant use rises with age and is highest among young adults. Antipsychotic prescriptions are less common than the other two types and peak during the teenage years. Boys are more likely than girls to receive stimulants and antipsychotics, but this difference becomes smaller in young adults. Most antidepressant and antipsychotic prescriptions come from psychiatrists, while primary care doctors write more stimulant prescriptions. The authors argue that these patterns match what is known about the conditions these medicines treat, like attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression. The use of antipsychotics may reflect the wide range of conditions they are used for. Simply put: The study found that the way these medicines are prescribed mostly matches the mental health needs of different age groups.

Abstract

OBJECTIVE: To describe national annual prescribing patterns of stimulant, antidepressant, and antipsychotic medications to young people. METHODS: Prescriptions for three commonly prescribed psychotropic classes (stimulants, antidepressants, and antipsychotics) to young people aged 3-24 years were analyzed from the IMS LifeLink LRx National Longitudinal Prescription database (n = 6,351,482). Denominators were adjusted to generalize estimates to the U.S. POPULATION: Comparisons are presented of percentages filling ≥1 prescription of each medication class during the study year stratified by patient sex, age, and prescriber specialty. RESULTS: The total annual percentage of prescriptions filled by youth for any of the three medication classes was by age 3-5 years (0.8%), 6-12 years (5.4%), 13-18 years (7.7%), and 19-24 years (6.0%). Stimulant use was highest for older children (age 11 = 5.7%). Antidepressant use tended to increase with age and was highest for young adults (age 24 = 4.8%). Annual antipsychotic prescription percentages were lower than antidepressant or stimulant percentages for all age groups, with a peak in adolescence (age 16 = 1.3%). Annual stimulant and antipsychotic percentages for males were higher than corresponding percentages for females, but converged for young adults. Psychiatrists and child psychiatrists accounted for most of the prescriptions of antidepressants (22.2%-53.2%) and antipsychotics (51.7%-70%), but fewer of the stimulant prescriptions (30.4%-36.2%). CONCLUSIONS: The age and sex distribution of stimulants and antidepressants among young people is broadly consistent with known epidemiologic patterns of their established indications for attention-deficit/hyperactivity disorder, anxiety, and depression. The pattern of antipsychotics may reflect the heterogeneity of disorders and conditions treated with this medication class.

Referenced In

Lee Johnson
2 months ago
A Scientific Review of Claims made by RFK Jr.

Claim: Psychiatric Medications are “Overprescribed” in the US

Verdict: Likely inaccurate, and highly misleading.

“Today, we take clear and decisive action to confront our nation’s mental health crisis by addressing the overuse of psychiatric medications—especially among children”

WTAS: HHS Launches MAHA Action Plan to Curb Psychiatric Overprescribing

This week, RFK Jr. and his Department of Health and Human Services announced a plan to curb “overprescribing” of psychiatric medications, with a particular focus on youth.

Ignoring more outlandish previous statements made by RFK Jr. on this topic, the key issue here is simple: are psychiatric medications “overprescribed” in the US?

What is “Overprescribing,” Anyway?

“Overprescribing” refers to people being prescribed a treatment that they didn’t technically “need,” likely because other, non-medication approaches would have been effective.

This is a legitimate issue, but it should be immediately clear that this is a decision that can only realistically be made on a case-by-case basis by a qualified healthcare provider. Simply looking at rising prescriptions for psychiatric medications is not enough to say there is “overprescribing.”

Prescription vs. Prevalence Rates for Psychiatric Conditions

Although we can’t definitively prove or disprove overprescribing with less granular data, we can still broadly address it. If prescriptions broadly move with the prevalence of the condition, widespread overprescribing is unlikely.

One study from 2018 tackled this exact issue, for stimulants, antipsychotics and antidepressants prescribed to young people. The study found that prescriptions for antidepressants and stimulants are broadly in line with the underlying rates of ADHD, depression and anxiety. For antipsychotics, it’s harder to estimate due to off-label medication use, but it also seems in line with prevalence estimates.

More recent data shows a continued increase in depression prevalence, so it would be expected that prescription rates would continue to increase.

Overprescribing or Underprescribing? It Depends Where You Look

Other data reveals another fundamental issue with the logic here. Rates of antidepressant prescriptions vary drastically by demographic group, as shown in the attached image. Should we conclude that antidepressants are underprescribed among men but overprescribed among non-binary people?

The reality is that a complex interplay of factors influences prescribing. Simply reducing this to “psychiatric medications are overprescribed” ignores between-group differences, the changing need for psychiatric medications and the overall reality that many people with mental health issues don’t receive any treatment at all.

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