From Our 2008 Archives

U.S. Kids Take More Psychotropic Drugs Than Europeans

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Sept. 24 (HealthDay News) -- American children are three times more likely to be prescribed psychotropic medications for conditions such as ADHD and bipolar disease than European children are, a new study finds.

Differences in regulatory practices and cultural beliefs about the benefit of medication for emotional and behavioral problems may explain this dramatic difference, the U.S. researchers added.

"There is significantly greater use of atypical antipsychotics and SSRI-type antidepressants for child mental health treatment in U.S. than in Western Europe," said lead researcher Julie Zito, from the pharmaceutical health services research department in the School of Pharmacy at the University of Maryland. "Since most of the use is 'off-label' -- without adequate evidence of benefits and risks, close monitoring should be considered when these medications are used."

The report was published in the Sept. 24 online edition of Child and Adolescent Psychiatry and Mental Health.

For the study, Zito's group looked at the use of antidepressants such as Prozac and stimulants such as Ritalin in the United States, the Netherlands and Germany.

Researchers found that the annual prevalence of psychotropic medications among children in the United States was significantly greater than in either the Netherlands or Germany. In the United States, 6.7 percent of children were taking these drugs, compared with 2.9 percent in the Netherlands and 2 percent in Germany.

In addition, use of antidepressants and stimulants was three or more times higher in the United States than in the Netherlands or Germany, and use of antipsychotic drugs was 1.5 to 2.2 times greater in the United States than in either of the other countries.

The difference in the use of these drugs may be partly due to differences in diagnosis systems. For example, in the United States, there are more diagnoses of bipolar disease among children and adolescents than there are in Europe, the researchers noted.

In addition, there are more child psychiatrists in the United States per capita than in Europe, and many children in the United States are taking two or more psychotropic drugs in a single year.

"Direct-to-consumer drug advertising, which is common in the U.S., is also likely to account for some of the differences. The increased use of medication in the U.S. also reflects the individualist and activist therapeutic mentality of U.S. medical culture," the researchers concluded.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, thinks finding out what accounts for these differences may be important in determining the best treatment for children with emotional and mental problems.

"It has been said many times that the U.S. has a sick-care system, rather than a health-care system, with a particular emphasis on use of drugs and procedures for diagnosed conditions," Katz said. "This study reaffirms that pattern, with more use of medication for various mental health conditions among children in the U.S than other countries."

What this study cannot show is whether the use of medication is appropriate, given variations in culture, or whether other countries under-prescribe psychotropic drugs or whether the U.S. over-prescribes them, Katz added.

"To make that determination, a comparison of outcomes associated with these differing practice patterns is required," Katz said. "The value in comparing and contrasting resides ultimately in gaining insights about best practices. We now know that practices vary, but don't know which pattern, if any, is demonstrably superior to the others."

SOURCES: Julie Zito, pharmaceutical health services research, School of Pharmacy, University of Maryland, Baltimore; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Sept. 24, 2008, Child and Adolescent Psychiatry and Mental Health, online

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