Antidepressant Prescribing by Pediatricians: A Mixed-Methods Analysis.
Anne K Tulisiak1, Jillian A Klein2, Emily Harris3
1Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH.
Current Problems in Pediatric and Adolescent Health Care
|January 7, 2017
Summary
Pediatricians are less likely to prescribe antidepressants for youth anxiety disorders than depressive disorders, despite similar efficacy. This is due to a preference for psychotherapy for anxiety and perceived lower impairment.
Area of Science:
- Child and Adolescent Psychiatry
- Pediatric Mental Health
- Pharmacotherapy Research
Background:
- Variability in pediatricians' use of antidepressants for youth with depressive and anxiety disorders is linked to knowledge gaps regarding efficacy, tolerability, dosing, and side effects.
- Qualitative factors influencing pediatricians' comfort and willingness to prescribe antidepressants are not well understood.
Purpose of the Study:
- To explore pediatricians' perceptions and factors influencing antidepressant prescribing for youth with depressive and anxiety disorders.
- To identify differences in prescribing likelihood between depressive and anxiety disorders in pediatric patients.
Main Methods:
- A mixed-methods approach utilizing in-depth interviews with 14 community-based and academic pediatricians.
- Inductive thematic analysis of audio-recorded interviews to identify key themes.
- Mixed models analysis to evaluate relationships between demographic factors, knowledge, and prescribing likelihood.
Main Results:
- Pediatricians perceive antidepressants as effective and well-tolerated for youth.
- Prescribing likelihood for antidepressants was significantly lower for anxiety disorders compared to depressive disorders with similar functional impairment.
- Factors influencing prescribing included symptom severity, age, psychotherapy availability, physician's knowledge/comfort, financial considerations, evidence base, and family dynamics.
Conclusions:
- Pediatricians exhibit a 'therapy first' approach for anxiety disorders, despite similar perceived efficacy and tolerability of antidepressants compared to depressive disorders.
- Lower antidepressant prescribing for anxious youth is attributed to perceptions of lower impairment and greater suitability of psychotherapy, not efficacy or tolerability concerns.
- Patient- and family-specific factors significantly influence antidepressant prescribing decisions in pediatric care.
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