psychotropic drugs, psychotropic medication
Darron Cummings/AP

American Children Given More Psychotropic Drugs than Europeans

September 30, 2008 01:00 PM
by Denis Cummings
According to a new study, American children are about three times as likely to be prescribed psychotropic medications such as Prozac and Ritalin than European children.

Study Compares American and European Psychotropic Drug Use

University of Maryland professor Julie M. Zito led the study, which examined administrative claims data from 2000 in the United States, Netherlands and Germany. It recorded the use of psychotropic medications by patients under the age of 19.

Psychotropic medications refer to drugs that affect a patient’s mind, emotions or behavior. They include antidepressants, anti-anxiety medication, mood stabilizers and stimulants. The antidepressant Prozac and the stimulant Ritalin are the most notable of psychotropic medications.

The study found that 6.7 percent of American children had been prescribed some form of psychotropic medication, compared to 2.9 percent of Dutch children and 2 percent of German children. More specifically, the study found that American children are about four times as likely to be prescribed stimulants and five times as likely to be prescribed antidepressants.
Zito concludes that there are many reasons for the large differences, including “cultural beliefs regarding the role of medication for emotional and behavioral treatment.” Americans are more exposed to drug advertising, have more access to expensive drugs, see more specialists, and are more likely to turn to drugs to solve their medical problems.

Dr. David L. Katz of the Yale University School of Medicine explains, “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. This study reaffirms that pattern, with more use of medication for various mental health conditions among children in the U.S than other countries.”

Zito believes that more care should be used when prescribing these drugs to children, some of whom are younger than the drug is intended for. “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,” she says.

Background: Children and psychiatric drugs

The use of psychiatric drugs by children has been rising steeply over the past two decades, increasing fivefold between 1993 and 2002. The rise, wrote The New York Times, “can be traced in part to the growing number of children and adolescents whose problems are given psychiatric labels once reserved for adults and to doctors' increasing comfort with a newer generation of drugs for psychosis.”

The increased use has attracted a great deal of criticism from those who believe that the drugs have side effects that have not yet been properly studied. This is especially the case for preschoolers, who are often too young to be taking the drugs according to the labels.

In 2000, Zito released a study that said “psychotropic medications such as Ritalin and Adderall were being prescribed to preschoolers at alarmingly high rates.” The study made national news and First Lady Hillary Clinton used it to call for an examination into whether Ritalin should be used by preschoolers.

It led to a study on Ritalin use by the National Institute of Mental Health. It found that children under six are more likely to have side effects, but that the drug is effective in treating children with severe ADHD or ADD. The study was criticized by psychiatrist Dr. Peter Breggin, who said, “This is a catastrophe. It just opens up the way for drugging the younger kids.”

Antidepressants are prescribed to improve the patient’s mood and emotions, but sometimes they can have an opposite effect. Antidepressants were linked to suicidal behavior, so much so that the Food and Drug Administration ruled in 2003 that antidepressants must carry a black box warning about suicide.
The warning may have led to an increase in suicides, however, as the suicide rate jumped 18 percent in 2004. Some experts believe that the warning discouraged patients who need the medication from taking it, leading to the suicide increase.

Related Topic: Stimulant use in Britain

National Institute for Health and Clinical Excellence (NICE), a health agency that advises Britain’s healthcare system, recently reported that too many children are being prescribed Ritalin and other stimulants. It advocated that children with ADHD and ADD receive psychological therapy before being out on stimulants.

Many British health experts believe that children are often prescribed stimulants because it is the easiest solution, but not necessarily the most effective. “There is an over-reliance on medicines,” said Dr. Tim Kendall, who helped to write the agency’s guidelines. “Its easier to prescribe a drug when other options like parent training programmes are not available.”

Though Britain was not involved in Zito’s study, her conclusion is that the cultural differences between the United States and Western Europe apply. It is widely considered that British children are prescribed fewer psychotropic medications than American children.

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