Journal of Child Psychology and Psychiatry Advances Reveals Troubling Findings
A recent article in the prestigious Journal of Child Psychology and Psychiatry Advances has raised concerns about the increase in antipsychotic prescriptions among children and adolescents in Australia’s primary care services between 2011 and 2017.
Research led by Julie Klau from the University of Adelaide has revealed disturbing trends showing that more off-label prescriptions were written for various conditions without enough evidence on efficacy of these drugs to treat symptoms appropriately.
Off-Label Prescriptions on the Rise: A Disturbing Trend
The study made use of electronic health records obtained from MedicineInsight to investigate antipsychotic prescription practices for young people in primary care across Australia.
These records provide information from a large proportion of general practitioners and practices across the country.
Analysis showed that there was a significant change in prescribing habits between 2011 and 2017.
For this purpose, we included 402 general practices that met specific criteria, focusing on service users identified as “regular patients.”
In 2011, it was found that 4.2% out of the total number of 168,009 children and adolescents studied were diagnosed with mental health issues. This percentage rose up to 6.7% by the end of 2017.
Antipsychotic Prescription Rates Surge Among Youths
The concern is primarily focused on the escalation in antipsychotic prescriptions. In fact, the figure stood at 3.2% up from a baseline measure in which only 2.2% were diagnosed with these medications by year-end 2017.
Notably, males and individuals living in disadvantaged neighborhoods are at higher risk of receiving such prescriptions.
Off-Label Prescriptions: A Cause for Alarm
Even much worse was that majority (79.7% as at end-2017) of these drugs were prescribed off-label while further investigation revealed that this figure had reduced to 69.8% by 2011.
In essence, this implies that these drugs were often prescribed even though there was insufficient evidence showing that they were effective for the diagnosed condition. In fact, in 2017, females experienced more of these off-label prescriptions than males.
Complex Diagnosis Patterns and Associated Prescriptions
The study, mentioned earlier, found that prescription rates changed depending on the type of diagnosis.
Apart from the increase in antipsychotic prescription, bipolar disorder diagnoses increased by 1%, autism without behavioral problems increased by 4%, and eating disorders increased by 7%.
Conversely, psychosis diagnoses decreased by 2.9 % while autism with behavioral problems and sleep disturbances fell over the same period.
Changing Landscape of Prescriptions by Diagnosis
Five years ago, most cases of depression/anxiety (56%), autism without behavioral problems (44%) and psychosis (43%) required antipsychotic treatment.
On the other hand, anxiety/depression only remained at the top with a slight decline from 52% to 51% during this period while autism without behavioral problems slightly rose from 41% to 42%.
It is also notable that disruptive behavior/conduct disorder replaced psychosis among the three most popular illnesses where such medicines were prescribed.
Acknowledged Limitations and Conclusions
There are several limitations noted by researchers for instance, a small proportion of children/adolescents was used in certain analyses and underreporting due to reluctance about mental health diagnosis.
However, overall conclusion suggests an alarming rise in off-label prescribing especially for depression/anxiety possibly influenced by under-trained or inexperienced GPs who may not have appropriate referral pathways or mentoring available to them.
Warnings of Long-Term Effects and Dangers
Use of antipsychotics among children has been criticized as being dangerous based on previous studies.
These drugs have been associated with severe long-term consequences such as brain atrophy, elevated diabetes risk and higher mortality levels among users.
However, despite warnings from experts of limited benefits and potential serious adverse effects, the prescriptions for children and adolescents continue to rise unabatedly.
The Implications and Need for Immediate Actions
The increase in children and adolescents taking antipsychotic drugs off-label along with the risks and limited advantages of these drugs shows that time is ripe for taking intervention measures.
Professionals stress evidence-based practices against prescribing such powerful medications without adequate scientific backing.
Enhanced training, mentorship and referral pathways are needed for healthcare practitioners dealing with mental health diagnoses in young patients, Australian research has demonstrated.
The effects of this research are not just limited to Australia but are a global concern that requires international attention to ensure the welfare of children and adolescents with mental health issues.
