Off-label use of psychotropic drugs in youth

Assess the prevalence of off-label psychotropic medication use in paediatric and adolescent outpatients, and to identify the most frequently prescribed drugs for various psychiatric conditions.

A cross-sectional study was performed using data from the Norwegian Prescription Database (NorPD) and responses to an electronic survey distributed to child and adolescent psychiatrists across Norway. The NorPD data used in this study was collected from January 1, 2019, through December 31, 2019. The electronic survey was sent out in January 2021 and was active until March 2021.

We analysed a total of 55,066 prescriptions, and identified that 55% of these were off-label. When medications for hyperkinetic disorders were excluded, the percentage of off-label prescriptions surged to 95%. Medicines for hyperkinetic disorder had the lowest proportion of off-label use (1%), while the medication class with the most off-label use was other agents, e.g. mood stabilising agents and hypnotics and sedatives (100%). The medicines that were most commonly prescribed were methylphenidate for hyperkinetic disorder, quetiapine for schizophrenia and bipolar disorder, sertraline for depressive disorder and anxiety/obsessive-compulsive disorder.

The off-label usage of psychotropic medications in children and adolescents is prevalent across most psychiatric disorders, with the exception of hyperkinetic disorder. This finding underlines the necessity for ongoing monitoring and assessment of prescription practices, as well as additional research into the safety and efficacy of psychotropic medications in this population.