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US youth appear not to be overmedicated for mental disorders

In a national survey, 14.2% of youth aged 13 to 18 years with any mental disorder reported that they had been treated with psychotropic medication, challenging recent concerns that US youth are overmedicated.

“Substantial concern has been raised about inappropriate prescribing of psychotropic medication to children and adolescents,” the researchers wrote. “However, these criticisms have been primarily based on anecdotal reports, studies of small unrepresentative clinical samples, and secondary analyses of large databases on prescription drug use that lack detailed clinical information about individual patients.”

Kathleen R. Merikangas, PhD, of the National Institute of Mental Health, and colleagues collected data on 10,123 adolescents who were part of the National Comorbidity Survey Adolescent Supplement, which was conducted from February 2001 to January 2004. In direct interviews, adolescents reported on psychotropic medication use and mental disorders were assessed using DSM-IV diagnostic criteria. A separate interview was used to collect information on mental health service use.

Psychotropic medication use was the most common among adolescents with attention-deficit/hyperactivity disorder (31%), followed by those with mood disorders (19.7%), eating disorders (19.3%), behavior disorders (19.3%), substance use disorders (14.4%) and anxiety disorders (11.6%). According to the researchers, only 2.5% of adolescents without a mental disorder were prescribed psychotropic medication.

Among adolescents with a major mood disorder, approximately 25% of antidepressant prescriptions were obtained through mental health services vs. 11.5% in general medicine and 0.3% in other medical settings.

Antidepressants were most commonly used by adolescents with primary mood disorders (14.1%). Among adolescents with ADHD (20.4%), stimulant use was the most common. Antipsychotic medication use was infrequent, reported by adolescents with a developmental disorder or learning disability (2%), bipolar disorder (1.7%) and a behavior disorder (1.8%).

“When neurodevelopmental disorders, lifetime history, and sub-threshold conditions are considered, there are few youths treated with psychotropic medications who did not have a serious behavioral, cognitive, or emotional disturbance,” the researchers said. “The match between specific disorders and indicated medications should also diminish criticism of medication use.”

Disclosure: The researchers report no relevant financial disclosures.