Psychiatric Medications Are Not Overprescribed for Kids, Finds Study

New York, NY (January 29, 2018) – A new study at Columbia University Irving Medical Center (CUIMC) challenges the popular notion that psychiatric medications are overprescribed in children and adolescents in the U.S. When the researchers compared prescribing rates with prevalence rates for the most common psychiatric disorders in children, they discovered that some of these medications may be underprescribed.

The findings were published online today in the Journal of Child and Adolescent Psychopharmacology.

“Over the last several years, there has been widespread public and professional concern over reports that psychiatric medications are being overprescribed to children and adolescents in the United States,” Ryan Sultan, MD, a child psychiatrist and researcher at CUIMC who led the study. “We were interested in better understanding this concern.”

How the study was done

Using data from a national prescription database, the researchers looked at annual prescriptions for three psychiatric drug classes—stimulants, antidepressants, and antipsychotics—for 6.3 million children between the ages of 3 and 24 years. They then compared prescribing patterns with known prevalence rates of attention deficit-hyperactivity disorder (ADHD), anxiety disorders, and depression between young children (3 to 5 years), older children (6 to 12 years), adolescents (13 to 18 years), and young adults (19 to 24 years).  This is the first national study to analyze prescription rates for these three types of psychiatric medications in youth.

Annually, an estimated 1 in 8 U.S. teenagers has a depressive episode, and roughly 1 in 12 children have symptoms of ADHD. During the year studied, fewer than 1 in 30 teenagers received a prescription for antidepressants, and only 1 in 20 got a prescription for stimulants.

“Our results show that, at a population level, prescriptions of stimulants and antidepressant medications for children and adolescents do not appear to be prescribed at rates higher than the known rates for psychiatric conditions they are designed to treat,” said Dr. Sultan. “These findings are inconsistent with the perception that children and adolescents are being overprescribed.”

Overall psychiatric drug prescription patterns in children and adolescents

Children in the youngest group accounted for the smallest number (0.8 percent) of prescriptions for any psychiatric drug. Adolescents accounted for the highest number (7.7 percent).

The number of prescriptions for stimulants was highest in older children (4.6 percent), with males accounting for more of these prescriptions than females. Antidepressant prescriptions increased with age and was highest for young adults (4.8 percent), particularly for females. Antipsychotic prescriptions peaked during adolescence (1.2 percent) and were prescribed slightly more often for males in this age group.

“The study also showed that, among young people in the United States, the patterns of prescriptions for antidepressants and stimulants are broadly consistent with the typical ages associated with the onsets of common mental disorders, said Mark Olfson, MD, professor of psychiatry at CUIMC and senior author of the paper. “However, the situation with antipsychotic medications is less clear cut. Given clinical uncertainty over their appropriate indications, it is unclear whether their annual use rates, which ranged from 0.1 percent in younger children to 1 percent in adolescents, are above or below the rates of the psychiatric disorders they aim to treat.”

“These results provide some reassurance to those who are concerned about the overprescribing of psychiatric medications to children and teenagers,” said Dr. Sultan. “Improving access to child psychiatrists through consultation services and collaborative care models may help address potential undertreatment while also reducing the risk of prescribing medications before other treatments have been tried. Acknowledging that prescription patterns may have changed since the data was collected, it is important to continue to assess the pattern and distribution of psychiatric medications to children and adolescents in the U.S.”

About the study

This study is titled, “National Patterns of Commonly Prescribed Psychotropic Medications to Young People.”

The other contributors are Christoph U. Correll (Northwell Health, Glen Oaks, NY), Michael Schoenbaum (Hofstra Northwell School of Medicine, Hempstead, NY), Marrisa King (Feinstein Institute for Medical Research, Manhasset, NY), and John T. Walkup (National Institute of Mental Health, Bethesda, MD).

The authors of this study have no disclosures.

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Columbia University Department of Psychiatry

Columbia Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Irving Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at Columbia University’s College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.