U.S. Kids Take More Psychotropic Drugs Than Europeans

Tag : Drugs & Medications

Differences in regulatory practices and cultural beliefs about thebenefit of medication for emotional and behavioral problems mayexplain this dramatic difference, the U.S. researchers added.
"There is significantly greater use of atypical antipsychotics andSSRI-type antidepressants for child mental health treatment in U.S.than in Western Europe," said lead researcher Julie Zito, from thepharmaceutical health services research department in the School ofPharmacy 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 areused."
The report was published in the Sept. 24 online edition ofChild andAdolescent Psychiatry and Mental Health.
For the study, Zito's group looked at the use of antidepressantssuch as Prozac and stimulants such as Ritalin in the United States,the Netherlands and Germany.
Researchers found that the annual prevalence of psychotropicmedications among children in the United States was significantlygreater than in either the Netherlands or Germany. In the UnitedStates, 6.7 percent of children were taking these drugs, comparedwith 2.9 percent in the Netherlands and 2 percent in Germany.
In addition, use of antidepressants and stimulants was three ormore times higher in the United States than in the Netherlands orGermany, and use of antipsychotic drugs was 1.5 to 2.2 timesgreater in the United States than in either of the other countries.
The difference in the use of these drugs may be partly due todifferences in diagnosis systems. For example, in the UnitedStates, there are more diagnoses of bipolar disease among childrenand adolescents than there are in Europe, the researchers noted.
In addition, there are more child psychiatrists in the UnitedStates per capita than in Europe, and many children in the UnitedStates 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. Theincreased use of medication in the U.S. also reflects theindividualist and activist therapeutic mentality of U.S. medicalculture," the researchers concluded.
Dr. David L. Katz, director of the Prevention Research Center atYale University School of Medicine, thinks finding out whataccounts for these differences may be important in determining thebest 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 useof drugs and procedures for diagnosed conditions," Katz said. "Thisstudy reaffirms that pattern, with more use of medication forvarious mental health conditions among children in the U.S thanother countries."
What this study cannot show is whether the use of medication isappropriate, given variations in culture, or whether othercountries under-prescribe psychotropic drugs or whether the U.S.over-prescribes them, Katz added.
"To make that determination, a comparison of outcomes associatedwith these differing practice patterns is required," Katz said."The value in comparing and contrasting resides ultimately ingaining insights about best practices. We now know that practicesvary, but don't know which pattern, if any, is demonstrablysuperior to the others."
More information
For more about children and mental health, visit the U.S. National Library of Medicine .
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, YaleUniversity School of Medicine, New Haven, Conn.; Sept. 24,2008,Child and Adolescent Psychiatry and Mental Health, online