Antipsychotic use declines among young children, but off-label prescribing continues
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Antipsychotic use has declined among young children, but clinicians continue to prescribe them off-label for conditions not approved by the FDA, researchers found.
“Earlier research detailed a concerning increase in antipsychotic use in young children,” Greta A. Bushnell, PhD, of the Center for Pharmacoepidemiology and Treatment Science at Rutgers University in New Jersey, told Healio Psychiatry. “While declines had since been noted in children enrolled in Medicaid, it was unknown whether declines in antipsychotic use had also occurred in privately insured children and whether declines had persisted into recent years.”
In a study published in Journal of the American Academy of Child & Adolescent Psychiatry, Bushnell and colleagues aimed to estimate annual antipsychotic medication use trends among privately insured children aged 2 to 7 years living in the United States. Study participants were young children who were included in a nationwide commercial claims database between 2007 and 2017. The investigators estimated annual antipsychotic use by age and sex, with use defined as the number of children dispensed an antipsychotic each year divided by the number enrolled. Further, they analyzed clinical diagnoses and mental health services utilization among participants with prescription antipsychotic use in 2009 and 2017.
Results showed annual antipsychotic use among young children was 0.27% in 2007 and peaked at 0.29% in 2009. By 2017, it had statistically significantly declined to 0.17%, for a linear trend of -0.017% per year (95% CI, -0.018 to -0.016). Boys had higher antipsychotic use than girls. More antipsychotic users received a mental health diagnosis in 2017 (89%) vs. 2009 (86%), with the most common clinical diagnoses among users being pervasive developmental disorder, conduct or disruptive behavior disorder and ADHD. In 2017, 32% of antipsychotic users had four or more psychotherapy claims, 43% had a psychiatric visit and most used another psychotropic medication, with a stimulant as the most common.
“Antipsychotic medications have concerning side effects and many long-term effects in young children are unknown,” Bushnell said. “By describing how antipsychotics are being used in this young population, we identify areas for future research and where efforts are needed to further improve antipsychotic prescribing in young children.”