Studies in the USA have shown that the use of psychotropic medications has increased considerably in recent years.¹ We have previously reported a similar trend in the UK.² However, there is little information on the prescribing trends in other countries; we do not know whether this is a global trend or a trend in English speaking countries. For the above reason, we used the IMS MIDAS Prescribing Insights to examine the prescribing trend of psychotropic medications in children in nine countries between the years 2000 and 2002.

METHODS

Children are defined as under 18 years old. The psychotropic medications investigated include antidepressants, stimulants, antipsychotics, benzodiazepines, and other anxiolytics.

IMS MIDAS Prescribing Insights contains the prescribing data from different countries. We obtained the paediatric psychotropic prescription data in the UK and three other European countries with the largest markets for these medications (France, Germany, and Spain), three South American countries with the largest markets for these medications (Argentina, Brazil, and Mexico) and North America (Canada and the USA).

IMS MIDAS Prescribing Insights is an audit drawn from a representative sample of medical practitioners in each country; table 1 summarises the details of data collection of each country. The prescribing data of sampled doctors were then adjusted according to the stratifications, and a projected national total of prescriptions data per year and 95.5% confidence intervals were calculated for each country. The within country differences of the data between years 2000 and 2002 were compared for significance.

RESULTS

Figure 1 shows that the number of psychotropic prescriptions for children has risen between the years 2000 and 2002 in all nine countries, and seven have shown a significant increase. The UK has the highest percentage increase (68%); the lowest was Germany (13%).

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Figure 1

 Psychotropic medication prescriptions given to patients aged 0–17 years by country and year (95.5% confidence intervals shown).

DISCUSSION

The results suggest that the increase in psychotropic prescribing in children is not only confined in the USA and UK but is also evident in other countries. The increase probably represents the improved recognition of paediatric psychopathology; there is also a concern that drugs are being used to replace non-drug treatments.³ However, there is insufficient research to confirm or refute the above suggestions. There are limitations to our data, especially as there is no information on the average prescription duration by drug or frequency, which may differ between years due to changes in prescribing practice. However, 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.

The recent recommendation by the Medicines and Healthcare products Regulatory Agency to withdraw selective serotonin inhibitors (SSRIs) from the treatment of paediatric depressive disorders⁴ should serve as a lesson to all of us. The percentage of SSRI prescriptions from all antidepressants prescriptions issued to children and adolescents in the UK increased considerably between 1992 and 2001;⁵ it is probable that the rationale for drug choice is not based on the research evidence in children, but based on the evidence in adults. This highlights an important point which paediatric clinical pharmacologists and pharmacists always advocate—“children are not small adults”.

Certainly we need more well designed clinical trials to investigate the safety and efficacy of psychotropic medications in children; it is also necessary to study how and why these medications are being prescribed, through the application of pharmacoepidemiology. We believe the use of psychotropic medications in children is a global public health issue, which should be studied in partnership with pharmaceutical companies, governments, and researchers to grow and expand the evidence base for their use in children.⁶ Children should not be deprived of safe and efficacious treatments.