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Antidepressant and antipsychotic use in an Italian pediatric population
Antonio Clavenna1, Margherita Andretta, Paola Pilati
1Laboratory for Mother and Child Health, Department of Public Health, Mario Negri Institute for Pharmacological Research, Milan, Italy. antonio.clavenna@marionegri.it
Insights
Psychotropic drug prescriptions for children remained stable, but incidence slightly rose. Most youths treated were not under specialist psychiatric care, highlighting a need for better monitoring of pediatric psychopharmacology.
Area of Science:
- Pediatric psychopharmacology
- Child and adolescent mental health services
- Public health surveillance
Background:
- The use of psychotropic medications in children is controversial due to limited long-term safety data.
- Italian psychotropic drug prescriptions for minors saw an increase in the early 2000s, followed by a decrease.
Purpose of the Study:
- To estimate the incidence and prevalence of psychotropic drug prescriptions in the pediatric population in Verona, Italy.
- To describe the diagnostic and therapeutic approaches for children prescribed psychotropic medications.
Main Methods:
- Analysis of administrative prescription data for 76,000 individuals under 18 in Verona (2004-2008).
- Questionnaires sent to prescribers for detailed information on diagnosis, treatment, and care strategies for patients receiving antidepressant and/or antipsychotic prescriptions (2005-2006).
Main Results:
- Psychotropic drug prescription prevalence remained stable from 2004-2008; incidence slightly increased (7.0 to 8.3 per 10,000).
- Anxiety-depressive syndrome and attention disorders were the most common indications for psychotropic drug use.
- Only 28 out of 111 treated youths (25%) received care from child and adolescent psychiatry services; 75% had psychological support.
Conclusions:
- Despite low overall prevalence, a significant gap exists in specialist psychiatric care for children on psychotropic medications.
- There is a critical need for systematic and continuous monitoring of psychopharmacological treatments in the pediatric population.
Background:
The safety and effectiveness of psychotropic drug use in the paediatric population is widely debated, in particular because of the lack of data concerning long term effects.In Italy the prevalence of psychotropic drug prescriptions increased in the early 2000s and decreased afterwards. In such a context, a study with the aim to estimate the incidence and prevalence of psychotropic drug prescription in the paediatric population and to describe diagnostic and therapeutic approaches was performed.
Methods:
The study population was composed of 76,000 youths less than 18 years and living in the area covered by the local health unit of Verona, Italy. The data source was the Verona local health unit's administrative prescription database. Prevalence and incidence of antidepressant and/or antipsychotic drug prescriptions in the 2004-2008 period were estimated. Children and adolescents receiving antidepressant and/or antipsychotic drug prescriptions between 1 January 2005 and 31 December 2006 were identified and questionnaires were sent to the prescribers with the aim to collect data concerning diagnostic and therapeutic approaches, and care strategies.
Results:
The prevalence of psychotropic drug prescriptions did not change in the 2004-2008 period, while incidence slightly increased (from 7.0 in 2005 to 8.3 per 10,000 in 2008). Between 1 January 2005 and 31 December 2006, 111 youths received at least one psychotropic drug prescription, 91 of whom received antidepressants. Only 28 patients attended child and adolescent psychiatry services. Information concerning diagnostic and therapeutic approaches, and care strategies was collected for 52 patients (47%). Anxiety-depressive syndrome and attention disorders were the diseases for which psychotropic drugs were most commonly prescribed. In all, 75% youths also received psychological support and 20% were prescribed drugs for 2 or more years.
Conclusions:
Despite the low drug prescription prevalence, the finding that most children were not cared for by child and adolescent psychiatric services is of concern and calls for a systematic, continuous monitoring of psychopharmacological treatments.
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