January 21, 2009
Psychotropic drugs are prescribed to children in the United States at three
times the rate of children in Europe, according to one of the first studies
to rigorously compare such prescription patterns between different
countries.
"There is significantly greater use of atypical antipsychotics and selective
serotonin reuptake inhibitor (SSRI)-type antidepressants for child mental
health treatment in U.S. than in Western Europe," lead researcher Julie Zito
said.
Zito and colleagues from the University of Maryland's School of Pharmacy
examined the prescription of psychotropic drugs, including stimulants such
as Ritalin and antidepressants such as Prozac, to more than 600,000 people
under the age of 20 in the United States, Germany and the Netherlands
between 1999 and 2000. They found that 6.7 percent of children in the United
States, 2.9 percent of those in the Netherlands and 2 percent of those in
Germany were taking at least one psychotropic drug at the time.
Among U.S. children between the ages of five and nine, the rate was more
than 8 percent, or four times the European rate. The use of more than one
drug at a time by U.S. children was also widespread.
Looking specifically at different classes of medications, the researchers
found that U.S. children were prescribed antidepressants and stimulants at
three or more times the rate of children in Europe, and antipsychotics at
between 1.5 and 2.2 times the European rate.
In the United States, more than 75 percent of psychotropic drugs were
prescribed to children "off-label," for uses not approved by the FDA.
The findings were published online in the journals Child and Adolescent
Psychiatry and Mental Health and BioMed Central.
Zito noted that the prescription of psychotropics in the United States has
probably increased in the eight years since the study's completion.
"The US trends appear to be continuing," she said.
The researchers proffered several possible explanations for the vast
differences in prescription rates between the United States and Europe.
Part of the difference may be due to different diagnosis systems, with less
stringent requirements in the United States for a diagnosis of mental
illness in children. For example, the criteria for a U.S. diagnosis of
attention deficit hyperactivity disorder (ADHD) are much easier to meet than
for the equivalent European hyperkinetic disorder. Likewise, a diagnosis of
childhood bipolar disorder is much more common in the United States.
Other differences in the medical establishments include a much higher per
capita number of child psychiatrists in the United States (meaning there are
more people to write psychotropic prescriptions) and the European public
health system's aversion to prescribing expensive, patented antidepressants
and antipsychotics. European doctors are also less comfortable prescribing
stimulants to children; the practice was actually banned in France while the
study was being conducted.
Another possible explanation is cultural: doctors and patients in the United
States are much more likely to turn to pharmaceutical remedies than
Europeans are.
"Direct-to-consumer drug advertising, which is common in the U.S., is also
likely to account for some of the differences," the researchers wrote. "The
increased use of medication in the U.S. also reflects the individualist and
activist therapeutic mentality of U.S. medical culture."
"It has been said many times that the U.S. has a sick-care system, rather
than a health-care system, with a particular emphasis on use of drugs and
procedures for diagnosed conditions," said David L. Katz, director of the
Prevention Research Center at Yale University School of Medicine. "This
study reaffirms that pattern, with more use of medication for various mental
health conditions among children in the U.S than other countries."
Zito warned that with most psychotropics being used by children off-label,
much more caution is needed in prescribing and post-prescription monitoring.
"Until we have better evidence, we need to be conducting close monitoring of
off-label use to assure parents that the benefits of medications outweigh
the risks of unnecessary use (when the benefit is inadequate) or risk of
adverse events such as increased glucose levels and lipid levels for youth
receiving atypical neuroleptics," she said.
http://mytechnologyworld9.blogspot.com/2009/01/americans-drug-their-children-with-300.html