Psychotropic drug prescribing for American youth has soared over the past
several decades (Psychiatric News, February 7, 2003), and now it
looks as though the same trend may be occurring in other countries, a new
The study was headed by Ian Wong, Ph.D., director of the Center for
Pediatric Pharmacy Research at the University of London. Results appeared in
the December Archives of Disease in Childhood.
Wong and his coworkers obtained data about psychotropic prescribing for
youth under 18 years of age in nine countries between 2000 and 2002. The
countries included France, Germany, Spain, and the United Kingdom—the
four European countries with the largest markets for these medications;
Argentina, Brazil, and Mexico—the three Latin-American countries with
the largest markets for these medications; and Canada and the United
Results indicated that the number of psychotropics prescribed for youth in
all nine countries rose between the years 2000 and 2002, and seven of the nine
countries showed a significant increase. The United Kingdom had the largest
percentage increase at 68 percent, while Germany had the smallest, 13
Wong told Psychiatric News that the results did not surprise him."
American data showed a similar trend a few years ago."
He also indicated that he was not surprised to find that the United Kingdom
is outpacing the United States in psychotropic prescribing for
"The U.S. already had a high baseline, so it can't really grow as
fast as the United Kingdom. There is no doubt, however, that we are catching
Psychiatric News likewise asked Wong whether there was more of an
increase in one category of psychotropic prescribing for youth in the
countries of interest than in another category—say, more SSRI
antidepressant prescribing than antipsychotic prescribing. Wong said that he
and his coworkers have already learned that both SSRI and stimulant
prescribing for youth increased significantly in the United Kingdom from 2000
to 2002, and that his team will now analyze more data from the United Kingdom
and the other countries to further answer this question.
Why psychotropic prescribing is surging not just in the United States, but
also in numerous other countries is not known. Wong and his colleagues,
however, offer several possible explanations in their study report: "The
increase probably represents the improved recognition of pediatric
psychopathology; there is also a concern that drugs are being used to replace
In any event, they pointed out, "The observed increase in so many
countries should raise concern, as little research has been conducted in
children to study the effects of most psychotropic medications" and
because of the brouhaha about antidepressants' possibly increasing suicide
risk in children (Psychiatric News, November 5).
"The use of psychotropic medications in children is a global public
health issue," Wong and his colleagues concluded, "which should be
studied in partnership with pharmaceutical companies, governments, and
researchers to grow and expand the evidence base for their use in
"The problem with this type of psychotropic medication market
research is that it contains no information about quality of the clinical
treatment that is associated with the use of these medications," Darrel
Regier, M.D., executive director of the American Psychiatric Institute for
Research and Education and director of APA's Division of Research, told
Psychiatric News. "In the absence of associated data on the
prevalence of treated and untreated mental disorders, and the degree to which
use of these medications follow established treatment guidelines, the author
is free to speculate about the implications of the increase in medication use
"If one starts from a public health perspective that there is
well-documented evidence of undertreatment of child and adolescent mental
disorders in all countries and that there is an attendant high level of
disability and waste of human potential because of the absence of treatment,
then the evidence of increased use of psychotropic medications could be seen
in very positive terms.
"If, on the other hand, one starts from a perspective that mental
disorders don't exist and that medications are a means whereby poor parenting
is being supported by inappropriate use of psychotropic medications, then
there is a very negative spin for this information.
"My concern is that the author adds a negative spin with an
incomplete reporting on the effectiveness data for psychotropic medications in
children and adolescents."
The study was funded by the Department of Health in England.
An abstract of the study, "Increased Prescribing Trends of
Pediatric Psychotropic Medications," is posted online at<http://adc.bmjjournals.com/cgi/content/abstract/89/12/1131?>.▪