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IN THE ABSTRACT

STUDY AND RESULTS: Researchers reviewed recent, relevant studies to examine the effectiveness of antidepressants in the treatment of child and adolescent unipolar, psychotic, nonpsychotic and major depression. Although many mental health professionals continue to prescribe antidepressants to children and adolescents, studies have presented mixed findings regarding their efficacy. Critiquing the latest studies in the area, the authors concluded that antidepressants alone usually are not effective in improving child and adolescent depression, and that they should be reserved for children who are not responding to psychotherapy and who are having difficulty with school and daily functioning.

WHAT'S IMPORTANT: Early recognition and treatment are necessary to prevent a host of negative outcomes for children and their families. In order to better equip children to deal with stressful life events, the authors recommend programs that teach parents how to build children's self-esteem and social and coping skills from an early age. Preventive intervention should target children who are at the highest risk for depression, and treatment for children with depression should take place within the context of the family.

FIND THIS STUDY: Zendi Moldenhauer and Bernadette Mazurek Melnyk. Pediatric Nursing 25, no. 6 (1999), 643-646.

STUDY AND RESULTS: The researchers examined the prevalence of psychotropic medication use in preschool-aged youths and utilization trends across a five-year span. The researchers used ambulatory care prescription records from two state Medicaid programs and a salaried group-model health maintenance organization (HMO) to perform a population-based analysis of three one-year cross sectional data sets (for the years 1991, 1993 and 1995). Three psychotropic medication classes were examined: stimulants, antidepressants and neuroleptics. The results show that psychotropic medication prevalence varied across the three sites. Stimulant treatment in preschoolers increased approximately threefold during the early 1990s. Antidepressants were the second most commonly prescribed psychotropic class of drugs for preschoolers, and their use increased from 1991 to 1993. Neuroleptic use was infrequent and relatively stable across the study period. Stimulant and antidepressant use in 1995 was considerably less among preschoolers in one of the Medicaid programs and the HMO than among those in the other Medicaid program. Neuroleptic use among enrollees in both Medicaid programs was more common than in the HMO.

WHAT'S IMPORTANT: A large increase was seen for all medications included in the study; this varied according to gender, age, geographic region and health care system. This finding is a good contribution to this area of research, because limited knowledge exists about the use of psychotropic medications in very young children. Disparities in psychotropic medication prevalence data between the two state Medicaid program populations may suggest numerous things, such as differences between state policies, occurrences of mental disorders in specific areas, preschool health assessment used in the area, physician specialty, cultural or familial values of the patient, and racial/ethnic populations in the area. Thus, there are still many unresolved questions involving the long-term safety of psychotropic medications in young children and the possible effects on a developing brain.

FIND THIS STUDY: Julia Magno Zito, et al. Journal of the American Medical Association 283, no. 8 (2000), 1025-1030.

STUDY AND RESULTS: The goal of this study was to compare patterns and predictors of psychotropic medication use by children and adolescents in the United States in 1987 and 1996. The authors analyzed medication use data from two nationally representative surveys of the general population, focusing on children age 18 or younger who used one or more prescribed psychotropic medications during the survey years. The results of the study showed that the overall rate of psychotropic medication use by children increased from 1.4 per 100 children in 1987 to 3.9 per 100 children in 1996. Significant increases were found in the rate of stimulant use, antidepressant use, other psychotropic medications, and coprescription of different classes of medication, especially antidepressants and stimulants. Rates of antipsychotic and benzodiazepine use remained stable. In 1996, stimulant use was especially common in children between the ages of 6 and 14, and antidepressant use was common in children between the ages of 15 and 18.

WHAT'S IMPORTANT: During the late 1980s and 1990s there was a dramatic increase in the use of psychotropic medications by children in the United States. This increase cuts across age, racial/ethnic, geographic, gender and insurance groups. A broadening of clinical concepts of stimulant-responsive psychiatric conditions may have further contributed to the increase in stimulant use. There also has been a substantial increase in antidepressant use by children and adolescents. African-American children are somewhat less likely than whites to receive stimulants and antidepressants, despite lack of evidence supporting racial differences in prevalence of ADHD or childhood depression. Thus, the source of racial and ethnic disparities in psychotropic medications requires further study. The absence of independent diagnostic data prevents the authors from evaluating the quality of the prescribing practices. In some cases, the medications are being used for the treatment of nonpsychiatric disorders. Combining use of psychotropic medications from several classes also has become more common, but further research is needed for better understanding of the significance of these trends.

FIND THIS STUDY: Mark Olfson, Steven C. Marcus, Myrna M. Weissman and Peter S. Jensen. Journal of the American Academy of Child and Adolescent Psychiatry 41, no. 5 (2002), 514-521.

STUDY AND RESULTS: The purpose of the study was to provide information regarding the prevalence of the use of prescription psychotropic medications by children and adolescents under age 20 in a large, geographically diverse, employer-insured population. The study focuses on therapeutic drug classes prescribed for the treatment of ADHD and/or depression, using data from several geographic regions of the United States over a recent period of time by age, gender, geographic region and prescriber specialty. The initial analysis included four therapeutic drug classes relevant to the treatment of ADHD or depression: central nervous system stimulants (CNSSs), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs) and other antidepressants (OADs).

WHAT'S IMPORTANT: The study shows a steady increase in the use of certain classes of psychotropic drugs-including CNSSs and SSRIs-among children and adolescents from 1995 to1999 in a large population across different geographic locations. Pediatricians were the most frequent first prescribers of CNSSs, but psychiatrists prescribed mainly SSRIs. According to the authors, the study's findings suggest that concern among the public about increasing use of psychotropics by children and adolescents holds for employer-insured populations, as well as for the Medicaid and the health maintenance organization populations. However, the rate of acceleration of the use of psychotropic medications in employer-insured populations is slower.

FIND THIS STUDY: Deborah Shatin and Carol Drinkard. Ambulatory Pediatrics 2, no. 2 (2002), 111-119.

STUDY AND RESULTS: In this report, the General Accounting Office (GAO) evaluated the diversion and abuse of attention disorder drugs and determined that abuse and theft are not rampant. Study methods included surveys of 1,033 principals (735 responding) and all state departments of education to examine the extent of theft and diversion of drugs and school policies surrounding medication. GAO found that principals, whether required by their state's laws or not, are taking measures to prevent the theft of medication. Although 90 percent of schools have students who are being treated for attention disorders, only 8 percent of principals reported a drug theft, and a majority of schools reported having less than 100 pills on hand.

WHAT'S IMPORTANT: This study finds that concerns about abuse stemming from school-handled medication are overstated. Schools are taking matters into their own hands to safely store medication; however, on many questions of medication safety, few states have set minimum standards.

FIND THIS STUDY: www.gao.gov, Report GAO-01-1011, Sept. 14, 2001.

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