Children throughout the world are increasingly being prescribed antidepressants and other drugs designed to calm or stimulate the brain, finds research in Archives of Disease in Childhood. Prescription rates increased the most in the UK, the research suggests.
In one study, researchers analysed prescribing trends in nine countries, based on information provided by an international database (IMS MIDAS) between 2000 and 2002. The database contains a representative sample of medical practitioners in each country.
The information was collected on children and adolescents up to the age of 17 in the UK, France, Germany, Spain, Canada, USA, Argentina, Brazil, and Mexico. Types of drugs included antidepressants, stimulants, tranquilisers and medication for psychotic episodes.
Significant rises in the number of prescriptions for these drugs were evident in all countries, except Canada and Germany. In Germany the increase was 13%, which was the lowest recorded. The highest increase of 68% was recorded in the UK.
The authors acknowledge that the increase might be due to better recognition of mental ill health among children and adolescents, and that medicines are being used instead of other non-drug treatments.
Little research has been done on the safety and effectiveness of psychotropic drugs in children, say the authors, adding that prescribing patterns in children are probably based on information drawn from research in adults.
They UK's regulatory agency the Medicines and Healthcare Products Regulatory Agency to recommendation to withdraw selective serotonin reuptake inhibitors (SSRIs) for treatment in children highlights the need for further research, they say.
And they conclude: "We believe the use of psychotropic medications in children is a global public health issue, which should be studied in partnership with pharmaceutical companies, governments, and researchers."
A second study in the journal assesses the rise in antidepressants prescribed to children under the age of 18 in the UK between 1992 and 2001.
It is based on information for children and adolescents up to the age of 18, supplied to a national database by family doctors (General Practice Research Database).
It shows that almost 25,000 children and adolescents were given 93,000 prescriptions, of which over half (55%) were for tricyclic antidepressants. A further four out of 10 prescriptions were for SSRIs.
The rate antidepressant prescriptions for children rose by 70% in a decade. While the rate for tricylics fell by 30%, that for SSRIs rose 10-fold from 0.5 children treated out of 1,000 to 4.6.
Tricyclics are licensed for the treatment of depression and night time bedwetting (nocturnal enuresis). But the medical records of most of the children up to 10 years of age, who had been prescribed tricyclics mentioned nocturnal enuresis, and not depression.
And almost half the adolescents with clinical depression had been prescribed tricyclics, despite the fact that these drugs are considered only moderately effective in this age group, say the authors.
Over two thirds (69%) of children and adolescents prescribed SSRIs were diagnosed with depression.
The average length of a prescription lasted 30 days for a tricyclic and 58 days for an SSRI. Over half of children and adolescents prescribed antidepressants stop taking them after two months.
International study: Dr Ian Wong, Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London, UK
Tel: +44 (0) 207 753 5933
Email: [email protected]
UK study: Mrs Macey Murray, Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London, UK
Tel: + 44 (0) 207 753 5933
Email: [email protected]
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