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Research Alert: March 28, 2002
Use of stimulants and antidepressant medications to treat ADHD (attention-deficit/hyperactivity disorder) and depression in children and adolescents increased steadily from 1995 to 1999, according to a new study funded by the Agency for Healthcare Research and Quality (AHRQ). The most commonly prescribed psychotropic classes of drugs—central nervous system stimulants (CNSSs) and selective serotonin reuptake inhibitors (SSRIs)—increased by 26 percent and 62 percent, respectively. The article is being published in the March-April 2002 issue of Ambulatory Pediatrics.
Researchers at the Center for Health Care Policy and Evaluation, UnitedHealth Group, with support from AHRQ's Center for Education and Research on Therapeutics at the University of North Carolina, studied how four therapeutic drug classes used to treat ADHD and depression in youth—CNSSs, SSRIs, tricyclic antidepressants (TCAs), and other antidepressants—vary in use over time by age, gender, geographic region, and prescribing physician. They used pharmacy and enrollment data from six geographically diverse UnitedHealth Group Independent Practice Association model employer-insured health plans. Researchers examined trends in physician prescribing practices of psychotropics for youth, but did not focus on the appropriateness of prescribing patterns or quality-of-care models.
The study also found:
- For CNSS patient use, the proportion of Ritalin® users decreased, while the proportion of Adderall® users increased.
- Among all children under 20 years, those receiving both CNSSs and SSRIs almost doubled from 1.4 to 2.6 per 1,000 over 5 years.
- The use of antidepressants other than SSRIs or TCAs by physicians for their patients increased by 195 percent overall.
- A child's first prescription for each CNSS prescribed came from a pediatrician 50 percent of the time and by a family practitioner 20 percent of the time. The first prescription for each SSRI prescribed was most likely given by a psychiatrist, although the proportion decreased from 56 to 44 percent during the study.
Researchers noted that these results confirm previously published research on the use of stimulants and antidepressants in children enrolled in both Medicaid and HMO plans.
Deborah Shatin, ACSW, Ph.D and Carol R. Drinkard, M.P.H. Ph.D, of the Center for Health Care Policy and Evaluation, UnitedHealth Group, co-authored the article: "Ambulatory Use of Psychotropics by Employer-Insured Children and Adolescents in a National Managed Care Organization."
Editor's Note: For more information or for an interview, please contact Dr. Shatin at (952) 936-5709. The study abstract will be available at www.ambpeds.org/journal.cfm.
For more information, please contact AHRQ Public Affairs, (301) 427-1364.