Kids' Use of Psychiatric Meds Triple

From the WebMD Archives

April 30, 2002 -- More kids are taking psychiatric drugs than ever before. Over the past decade, the number of kids taking medications for depression, attention deficit hyperactivity disorder (ADHD), or other behavior problems has tripled.

In a new study, researchers analyze data between 1987 and 1996, focusing on medication use among more than 50,000 people including more than 17,000 children aged 18 and younger.

They found "a dramatic increase" in the use of psychiatric medications by children which cuts across age, racial/ethnic, geographic, gender, and insurance groups, and included stimulants used for ADHD, antidepressants, and other such medications, according to Mark Olfson, MD, MPH, associate professor of clinical psychiatry at Columbia University in New York.

Olfson reports his findings in the May issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

However, despite the increases, "we know there are substantial numbers of children who are still not being treated for psychiatric disorders," Olfson tells WebMD.

Among his findings:

  • During the 10-year period, overall use of psychiatric medications in children and adolescents more than tripled.
  • Use of stimulants for ADHD increased four-fold, from six to 24 per 1,000 children and adolescents.
  • Use of antidepressants by children more than tripled, from three to 10 children per 1,000.
  • Among children already on one psychiatric medication, the number who were on multiple such drugs almost tripled from 47 to 116 children per 1,000. Antidepressants and stimulants were most commonly prescribed together.

"As these medications are around longer and longer, they've become more accepted," says Jeff Epstein, PhD, director of the ADHD program at Duke University Medical Center.

Since stimulants were introduced in the mid-1960s, they have been extensively studied, Epstein tells WebMD. "We have lots of studies showing their side effects and how effective they are, so people tend to accept them."

The antidepressants commonly prescribed to young people, known as SSRIs (selective serotonin reuptake inhibitors) "have been even more rapidly accepted, possibly because parents themselves are taking them -- I think that's part of it," says Epstein.


However, few studies have been done to show how effective SSRIs are in treating children, say both Olfson and Epstein. SSRIs include Celexa, Paxil, Prozac, and Zoloft.

"There are probably fewer than 10 studies [of antidepressants], whereas with stimulants, there are hundreds and hundreds of studies," says Epstein. "That's concerning to me, that pediatricians or psychiatrists are prescribing them at really high rates without knowing if they work."

Also, SSRIs have only been FDA approved for treatment of children with obsessive-compulsive disorder. "None of the antidepressants have been FDA approved for treatment of childhood depression," Olfson points out. "There is some data to support their effectiveness, but how they do over the longer term awaits further study."

The high numbers of children taking more than one psychiatric medication are of even more concern to Epstein. "There are no studies showing that a combination works, or that it's safe or effective," he tells WebMD.

In his study, Olfson identified a handful of examples of children under age six who were taking psychiatric medications. "Although rare, it does exist," Olfson says.

"There has been no scientific evidence to date that there should be reason for concern," points out Epstein. "I haven't seen any data yet that brains of kids who took these drugs are any different than brains of kids who didn't take these drugs. But with the really young kids, it's an ethical thing -- these are young kids, this is the period of fastest time of brain growth."

Epstein's program is one of six sites in an NIH-funded study looking at stimulant use in preschool children. "It's really going to tell us whether it's safe and effective to use these drugs in preschoolers," he tells WebMD. Duke is also participating in a study looking at combinations of SSRIs and stimulants in kids who have ADHD and anxiety.

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