Antipsychotic prescriptions for children increased by 3.3% annually over 2 decades

The prevalence of all antipsychotic prescriptions prescribed to those aged 3 to 18 years increased by an average of 3.3% annually from 2000 to 2019, researchers reported in The Lancet Psychiatry.

“Studies across the globe have raised concerns that antipsychotics are increasingly prescribed to children and adolescents. Although this trend might be appropriate with changing clinical needs, most antipsychotics are not licensed for use in children and adolescents because of incomplete safety profiles, particularly for long-term use,” Maja R. Radojcic, PhD, of the University of Manchester in the United Kingdom, and colleagues wrote.

Radojcic and colleagues used a large primary care database and included children and adolescents aged 3 to 18 years who were registered in England between 2000 and 2019, to describe trends in antipsychotic prescribing.

The authors reported that participants were followed until the earliest of Dec. 31, 2019, June 30 of the year they turned age 18, their death, when they transferred to a primary care practice or when their practice left the database.

A total of 7,216,791 children and adolescents were included (51.8% male; mean age, 7.3 years), and there was a mean follow-up of 4.1 years. A total of 19,496 individuals received 243,529 antipsychotic prescriptions over follow-up, which included 225,710 atypical and 17,819 typical antipsychotic prescriptions.

The annual period prevalence of antipsychotic prescriptions rose from 0.057% (95% CI, 0.052%-0.063%) in 2000, to 0.105% (95% CI, 0.100%-0.111%) in 2019. In addition, the period prevalence of all antipsychotic prescriptions increased by an average of 3.3% annually (95% CI, 2.2%-4.9%). In addition, the rate of first prescriptions increased by 2.2% annually (95% CI, 1.7%-2.7%).

The authors reported that the most likely indications for the first identified antipsychotic prescriptions were for autism spectrum disorders (2,477; 12.7%), non-affective psychosis (1,669; 8.6%), anxiety disorders (1,466; 7.5%), ADHD (1,391; 7.1%), depression (1,256; 6.4%) and conduct disorders (1,181; 6.1%).

“The observed increase in antipsychotic prescriptions over 20 years results from the accumulation of repeated prescriptions to the same individuals combined with an increase in new prescriptions,” Radojcic and colleagues wrote. “These findings highlight the need for continued monitoring of trends in antipsychotic use and, although this was not examined in this paper, the findings highlight the need for better information about long-term antipsychotic safety.”