New research finds a concerning number of children are being prescribed antipsychotic drugs, most for off-label conditions.
A new article published in the Journal of Child Psychology and Psychiatry Advances finds that antipsychotic prescriptions for children and adolescents rose significantly between 2011 and 2017 in Australian primary care services.
The current research, headed by Julie Klau of the University of Adelaide, reveals that the majority of antipsychotic prescriptions written by general practitioners were for off-label complaints. This means these drugs were commonly prescribed to children with little to no evidence that they could treat their symptoms. Additionally, most of the service users prescribed antipsychotics were also prescribed other psychotropic drugs simultaneously.
The authors write:
“Prescribing antipsychotics for mental health diagnoses to children/ adolescents attending Australian general practices was more frequent in 2017 than in 2011 and most commonly associated with depression/anxiety diagnoses. In both years, most prescribing was off‐label. The majority of patients were co‐prescribed other classes of psychotropics along with antipsychotics.”
The goal of the current research was to examine antipsychotic prescription practices for children and adolescents in Australian primary care services. To accomplish this goal, the researchers used electronic healthcare records stored in MedicineInsight, an extensive healthcare and demographic information database established in 2011. 7% of all general practices and 9% of all general practitioners in Australia contribute data to MedicineInsight. The current study compared MedicineInsight data from 2011 and 2017.
To be included in the current research, practices had two years of continuous data with no interruptions of more than six weeks. The authors excluded practices that had significant changes in patient numbers over time. Data from 402 general practices was included in the current study.
For service user data to be included in the current research, they had to be “regular patients,” meaning they visited the same general practice at least three times within two years with at least one visit each year. This criteria resulted in 168,009 children and adolescents in 2011 and 301,643 in 2017.
In 2011, 8418 of 168,009 children and adolescents (4.2%) received a mental health diagnosis, compared to 27,412 of 301,643 (6.7%) in 2017. 191 of 8418 children and adolescents who received a mental health diagnosis (about 2.2%) were prescribed antipsychotics in 2011 compared to 893 of 27,412 (about 3.2%) in 2017.
Males were more likely than females to receive a prescription for antipsychotics in both 2011 and 2017, as were children/adolescents from less advantaged neighborhoods.
Children and adolescents diagnosed with bipolar disorder were significantly more likely to be prescribed antipsychotics in 2017 (41.5%) than in 2011 (21.6%). Those diagnosed with autism without exhibiting behavioral problems also saw a significant increase in antipsychotic prescriptions in 2017 (6.1%) compared to 2011 (3.7%). Children diagnosed with an eating disorder were six times more likely to be prescribed antipsychotics in 2017 (7.2%) compared to 2011 (1.1%). Diagnoses of conduct disorder, ADHD, depression, and anxiety were also more likely to be medicated with antipsychotics in 2017 compared to 2011.
Children and adolescents diagnosed with psychosis were less likely to be prescribed antipsychotics in 2017 (34%) compared to 2011 (45.7%). The same was true for autism with behavioral problems (8.9% in 2017 vs 10.8% in 2011) and sleep disorders (0.4% in 2017 vs 0.9% in 2011).
In 2011, the most common diagnoses that received antipsychotic prescriptions were depression/anxiety (26.8% of prescriptions), autism without behavioral problems (22.3% of prescriptions), and psychosis (17.8% of prescriptions). In 2017, 30.8% of antipsychotic prescriptions went to children/adolescents with anxiety/depression diagnoses, while 25.2% went to those diagnosed with autism without behavioral problems. Psychosis was replaced by disruptive behavior/conduct disorder (9.8% of prescriptions) as the third most common diagnosis that received antipsychotic prescriptions in 2017.
Off-label prescribing of antipsychotics (prescribing antipsychotics to treat conditions they are not approved to treat) represented the majority of prescriptions in both 2017 (79.7%) and 2011 (69.8%). The authors note that off-label prescribing was more common for females than for males in 2017. Co-prescribing was also common, as 69% of children and adolescents who received a prescription for antipsychotics in 2017 and 2011 were prescribed other psychotropics on the same day. The most common drugs given alongside antipsychotics were antidepressants, followed by ADHD medications.
The authors acknowledge several limitations to the current research. The number of children/adolescents included in some analyses was low. Some service users received more than one diagnosis in a year, making it unclear which diagnosis resulted in a prescription for antipsychotics. The current study may not capture diagnoses made by specialists rather than general practitioners. General practitioners are sometimes reluctant to make diagnoses to avoid stigma for their patients. This means the number of off-label prescriptions may be artificially inflated by general practitioners’ reluctance to diagnose mental health conditions. The research was conducted entirely in Australia, limiting generalizability to other populations.
The authors conclude:
“Overall, the findings suggest an increase in GP off‐label prescribing from 2011 to 2017, especially for depression/anxiety. There also appears to be an increasing tendency for patients in more disadvantaged areas to be prescribed antipsychotics for mental disorders and a growing tendency to prescribe more to females. These changes in prescribing may be partly due to GPs having inadequate training and mentoring and a lack of appropriate referral pathways.”
Antipsychotics can have dangerous long-term effects and often lead to poor outcomes for service users. Previous research has linked antipsychotic use in children to brain atrophy, increased risk for diabetes, and increased risk of death. Although experts have warned about the dangers of giving antipsychotics to children, prescriptions for children and adolescents are on the rise. Off-label antipsychotic prescriptions for ADHD in children are common despite experts warning that “there is little evidence of benefit and substantial evidence of potential harm.”
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Klau, J., Gonzalez‐Chica, D., Raven, M., & Jureidini, J. (2023). Antipsychotic prescribing patterns in children and adolescents attending Australian General Practice in 2011 and 2017. JCPP Advances. https://doi.org/10.1002/jcv2.12208 (Link)