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Mental Health

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Primary care physicians often prescribe psychotropic drugs to treat hyperactivity and depression in children

A growing number of primary care doctors are prescribing psychotropic (mind-altering) medications for children with mood disorders or attention-deficit hyperactivity disorder (ADHD), even though primary care physicians typically have limited training in use of these drugs for these conditions.

During the early 1990s, it became more common for child psychiatrists to use more than one psychotropic medication for a child, for example, adding newer antidepressants such as serotonin selective reuptake inhibitors (SSRIs) to central nervous system stimulants (CNSSs, such as Ritalin) for children and adolescents with ADHD and coexisting depression. Because of the variability involved in treating ADHD and depression, the common presence of other conditions, and uncertainties about the effects of psychotropic drugs on the developing brain, there is concern about the appropriate use of these medications in children.

In a recent study, Deborah Shatin, A.C.S.W., Ph.D., and Carol R. Drinkard, M.P.H., Ph.D., of UnitedHealth Group in Minnesota, analyzed 1995-1999 claims data for children younger than age 20 in six independent practice association health plans from four different geographic regions affiliated with UnitedHealth Group. For the study, which was supported in part by the Agency for Healthcare Research and Quality (HS10397 to the University of North Carolina Center for Education and Research on Therapeutics [CERT]), Drs. Shatin and Drinkard calculated the prevalences of use of four psychotropic drug classes: CNSSs, SSRIs, tricyclic antidepressants (TCAs), and other antidepressants (OADs).

Over the 5-year period, use of CNSSs increased 26 percent, SSRI use increased 62 percent, use of other antidepressants increased 195 percent, and use of TCAs decreased 21 percent. Pediatricians made up half and family doctors 20 percent of the first prescribers of CNSSs in 1995 compared with 13 percent of psychiatrists (which increased to 18 percent by 1999). Psychiatrists were most likely to prescribe SSRIs (56 percent in 1995 declining to 44 percent by 1999). However, the proportion of pediatricians and family doctors prescribing this class of drugs increased from 7 and 13 percent, respectively, in 1995 to 23 and 28 percent, respectively, in 1999. These findings underscore the importance of training and expertise among primary care physicians in the use of psychotropic medications in youths, conclude the researchers.

See "Ambulatory use of psychotropics by employer-insured children and adolescents in a national managed care organization," by Drs. Shatin and Drinkard, in the March 2002 Ambulatory Pediatrics 2, pp. 111-119.

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