MONDAY Sept. 30, 2013 — Doctors don’t seem to be as quick as they once were to reach for their prescription pads when treating preschoolers for mental troubles, a new study shows.
The research, published online Sept. 30 in the journal Pediatrics, looked at recent trends in the use of psychotropic medications — drugs that alter mood or behavior — in children between the ages of 2 and 5.
After reaching a peak between 2002 and 2005, the use of drugs such as stimulants and antidepressants to treat attention-deficit hyperactivity disorder (ADHD) and depression, respectively, leveled off between 2006 and 2009, even though diagnoses of those disorders climbed over the same time period.
The study suggests that doctors may be using treatments such as behavioral therapy and counseling, instead of prescriptions, to help young kids.
“Our study couldn’t determine that, but that’s my biggest hope, that children are getting services to address their issues in a non-medication type of way,” said study author Dr. Tanya Froehlich, a pediatrician at Cincinnati Children’s Hospital in Ohio.
Experts attribute the decrease, in part, to greater awareness on the part of physicians and parents about the potential dangers of some commonly prescribed medications.
The U.S. Food and Drug Administration, for example, issued its highest level warning in 2004 to alert doctors that antidepressants could increase the risk of suicidal thoughts and actions in children. And in 2006, the FDA considered a similar warning about the risks of heart problems in people who take stimulant medications to treat ADHD. Though that warning was never added to drug labels, Froehlich says the controversy may have given doctors second thoughts about putting very young children on these kinds of drugs.
The dip was significant enough that a child diagnosed with a behavioral disorder from 2006 to 2009 was about half as likely to receive a prescription to treat the condition as a child diagnosed between 1994 and 1997.
“People have the impression that the psychotropic use is just climbing and it’s just this inexorable increase year after year,” Froehlich said. “So I think it’s important for people to realize that there has been stabilization, as much as we can tell.”
However, the research did reveal increased use of these medications among certain groups: boys, white children and kids without private health insurance during the overall study period, 1994-2009.
ADHD was the most common diagnosis, the researchers found, and stimulants to treat it were the most frequently prescribed psychiatric medications.
The study took its data from government surveys of more than 43,000 pediatric visits to doctor’s offices and outpatient clinics across the United States. The 2006 to 2009 visits were the most recent years for which data was available. Froehlich said it’s too early to say whether the trend will continue.
Not everyone agrees that the decline in psychotropic medication use was healthy.
“I think the decrease in prescribing is not necessarily a good thing,” said Dr. Matthew Lorber, acting director of child and adolescent psychiatry at Lenox Hill Hospital in New York City.
Lorber also thinks the decline is related to the FDA’s warning about suicidal thoughts and antidepressants. He said that’s a warning that’s been largely misconstrued.
“Their goal wasn’t to have doctors prescribe them less. It was to have them follow up [with patients] more,” he said.
Lorber cited a study published in September 2007 in the American Journal of Psychiatry that found rates of suicide had increased in children and adolescents since the black box warning was issued. The study, he said, could be an indication that antidepressants are being underused in kids.
Still, there are very few studies of psychotropic medication use in very young children. And many doctors aren’t comfortable prescribing the drugs off-label — in this case, giving medications to preschoolers that have only been approved for older children or adults.
“I think we have to be really thoughtful about the use of these medications because we don’t really know what they’re doing to the brains of developing children,” Froehlich said.