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Antipsychotic prescriptions increased for adults and children

Adults made considerably more medical visits that included a prescription of antipsychotics than adolescents and children, but antipsychotic treatment has increased rapidly among young people, according to study results.

“Over the past several years, an increasing number of adults and children in the United States have been treated with antipsychotic medications,” the researchers wrote. “Antipsychotics are now among the most commonly prescribed and costly classes of medications.”

Mark Olfson, MD, MPH, professor of clinical psychiatry at Columbia University, and colleagues compared national trends of antipsychotic treatment of 484,889 children, adolescents and adults whose office-based visits were recorded in the National Ambulatory Medical Care Surveys from 1993 to 2009.

Results show that visits with a prescription of antipsychotic medications per 100 persons increased from 0.24 to 1.83 for children, 0.78 to 3.76 for adolescents and 3.25 to 6.18 for adults. The proportion of visits that included a prescription of antipsychotics increased from 0.16% to 1.07% for youths and from 0.88% to 1.73% for adults. According to the researchers, between 2005 and 2009, disruptive behavior disorders were the most common diagnoses in children (63%) and adolescents (33.7%) who were prescribed antipsychotic medications. Depression (21.2%) and bipolar disorder (20.2%) were the two most common diagnoses in adults.

Olfson and colleagues found that psychiatrists provided a larger proportion of the antipsychotics for children (67.7%) and adolescents (71.6%) vs. adults (50.3%; P<.001). From 2005 to 2009, 28.8% of adult visits and 31.1% of youth visits to psychiatrists included antipsychotic medications.

The most commonly prescribed drugs among adults were quetiapine (Seroquel, AstraZeneca; 32.6%), risperidone (Risperdal, Janssen Pharmaceuticals; 16.9%), olanzapine (Zyprexa, Lilly; 15.2%) and aripiprazole (Abilify, Otsuka; 13.8%). Among adolescents, aripiprazole (29%), quetiapine (26.8%), risperidone (23%) and olanzapine (9.3%) were the most commonly prescribed, and risperidone (42.1%), aripiprazole (28%), quetiapine (19.2%) and olanzapine (4.4%) were the most common among children.

The researchers found that most of the visits involving antipsychotic prescriptions did not include a diagnosis for which the antipsychotic had FDA approval for the patient age group. For example, almost two-thirds of child antipsychotic visits between 2005 and 2009 included a disruptive disorder diagnosis, for which there are currently no FDA-approved medications.

“In light of known safety concerns and uncertainty over long-term risks and benefits, these trends may signal a need to reevaluate clinical practice patterns and strengthen efforts to educate physicians, especially primary care physicians, concerning the known safety and efficacy of antipsychotic medications in conditions for which they are commonly prescribed but for which the evidence base remains underdeveloped,” the researchers wrote.

Disclosure: Dr. Olfson reported working on grants to Columbia University from Eli Lilly and Bristol-Myers Squibb. See study for the full list of financial disclosures.