Correlating Psychotropic Use to Major Depressive Disorder and ADHD Research Diagnoses: Trends in a Prospective
Miranda U Liang1,2, Natchanan Charatcharungkiat3, Rebecca Tillman3
1Washington University School of Medicine, St. Louis, Missouri.
Insights
Psychotropic medication use in children, particularly antipsychotics, increased with age and severity, not always aligning with specific diagnoses. Black children with major depressive disorder received antidepressants less frequently than White children.
Area of Science:
- Child and Adolescent Psychiatry
- Psychopharmacology
- Developmental Psychology
Background:
- Psychotropic medication use is common in pediatric populations.
- Understanding the relationship between diagnosis, severity, and medication is crucial for effective treatment.
- Longitudinal data in pediatric research cohorts are essential for tracking developmental trends in psychotropic use.
Purpose of the Study:
- To investigate the associations between psychotropic medication usage and clinical characteristics in a pediatric research cohort.
- To analyze trends in psychotropic use across different age groups (preschool, school-age, adolescence/early adulthood).
- To explore the relationship between medication use, diagnostic criteria, and symptom severity.
Main Methods:
- A prospective longitudinal cohort of 348 children (ages 3-21) with mood and externalizing symptoms was studied.
- Data on psychotropic medication use, research diagnoses (DSM-IV, DSM-5), and disease severity were collected at up to 10 time points.
- Standardized research interviews and caregiver/self-report questionnaires were utilized for data acquisition.
Main Results:
- Attention-deficit/hyperactivity disorder (ADHD) medication use increased from 20.7% in preschool to 84.0% in adolescence/early adulthood.
- Antidepressant use for major depressive disorder (MDD) rose from 0% in preschool to 42.6% in adolescence/early adulthood.
- Antipsychotic use peaked in school-age children, and concurrent use with other psychotropics was linked to higher comorbidity and severity. Black children with MDD had significantly lower antidepressant use compared to White children.
Conclusions:
- Psychotropic use, especially antipsychotics, appears more associated with symptom severity and impairment than specific diagnoses in younger children.
- The concordance between diagnosis and psychotropic prescription increases with age.
- Disparities in antidepressant use were observed between Black and White children with MDD, highlighting potential inequities in care.
Abstract:
To examine the associations of psychotropic usage to clinical characteristics in a pediatric research cohort with research diagnoses and severity scores.
Abstract:
The cohort (N = 348) was enriched for children with mood and externalizing symptoms. Prospective longitudinal data were collected from ages 3 to 21 (September 2003-December 2019). At up to 10 time points, data on psychotropic medication use were collected by caregiver- and self-report from the MacArthur Health and Behavior Questionnaire, Parent Version and as part of the diagnostic interview, and research diagnoses (DSM-IV and DSM-5) and disease severity scores were acquired using an age-appropriate standardized research interview (Preschool Age Psychiatric Assessment, Child and Adolescent Psychiatric Assessment, Kiddie-Schedule for Affective Disorders and Schizophrenia).
Abstract:
The percentage of children with attention-deficit/hyperactivity disorder (ADHD) taking ADHD medications was preschool, 20.7%; school-age, 65.4%; and adolescence/early adulthood, 84.0%. The percentage with major depressive disorder (MDD) who were taking antidepressants was preschool, 0%; school-age, 21.6%; and adolescence/early adulthood, 42.6%. Antipsychotic use in children with research diagnoses of ADHD or MDD peaked in school-age: ADHD, 30.8%, and MDD, 21.6%. Children who were taking an antipsychotic concurrently with an ADHD medication or antidepressant had more comorbid conditions and higher disease severity than those taking ADHD medications or antidepressants without concurrent antipsychotics. Black children with MDD used antidepressants significantly less than White children with MDD (Black = 12.1%, White = 31.9%, FDR P = .0495).
Abstract:
Concordance between research diagnosis and psychotropic use increased with age. Antipsychotic use was quite high, though more frequent in children with higher disease severity. Both findings suggest that psychotropic use is less tied to discrete diagnoses at earlier ages and that antipsychotic medication use may be motivated by severity/impairment rather than diagnosis.
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