MONDAY, Sept. 30 (HealthDay News) -- Doctors don't seem to be as
quick as they once were to reach for their prescription pads when
treating preschoolers for mental troubles, a new study shows.
The research, published online Sept. 30 in the journal
Pediatrics, looked at recent trends in the use of
psychotropic medications -- drugs that alter mood or behavior -- in
children between the ages of 2 and 5.
After reaching a peak between 2002 and 2005, the use of drugs
such as stimulants and antidepressants to treat attention-deficit
hyperactivity disorder (ADHD) and depression, respectively, leveled
off between 2006 and 2009, even though diagnoses of those disorders
climbed over the same time period.
The study suggests that doctors may be using treatments such as
behavioral therapy and counseling, instead of prescriptions, to
help young kids.
"Our study couldn't determine that, but that's my biggest hope,
that children are getting services to address their issues in a
non-medication type of way," said study author Dr. Tanya Froehlich,
a pediatrician at Cincinnati Children's Hospital in Ohio.
Experts attribute the decrease, in part, to greater awareness on
the part of physicians and parents about the potential dangers of
some commonly prescribed medications.
The U.S. Food and Drug Administration, for example, issued its
highest level warning in 2004 to alert doctors that antidepressants
could increase the risk of suicidal thoughts and actions in
children. And in 2006, the FDA considered a similar warning about
the risks of heart problems in people who take stimulant
medications to treat ADHD. Though that warning was never added to
drug labels, Froehlich says the controversy may have given doctors
second thoughts about putting very young children on these kinds of
The dip was significant enough that a child diagnosed with a
behavioral disorder from 2006 to 2009 was about half as likely to
receive a prescription to treat the condition as a child diagnosed
between 1994 and 1997.
"People have the impression that the psychotropic use is just
climbing and it's just this inexorable increase year after year,"
Froehlich said. "So I think it's important for people to realize
that there has been stabilization, as much as we can tell."
However, the research did reveal increased use of these
medications among certain groups: boys, white children and kids
without private health insurance during the overall study period,
ADHD was the most common diagnosis, the researchers found, and
stimulants to treat it were the most frequently prescribed
The study took its data from government surveys of more than
43,000 pediatric visits to doctor's offices and outpatient clinics
across the United States. The 2006 to 2009 visits were the most
recent years for which data was available. Froehlich said it's too
early to say whether the trend will continue.
Not everyone agrees that the decline in psychotropic medication
use was healthy.
"I think the decrease in prescribing is not necessarily a good
thing," said Dr. Matthew Lorber, acting director of child and
adolescent psychiatry at Lenox Hill Hospital in New York City.
Lorber also thinks the decline is related to the FDA's warning
about suicidal thoughts and antidepressants. He said that's a
warning that's been largely misconstrued.
"Their goal wasn't to have doctors prescribe them less. It was
to have them follow up [with patients] more," he said.
Lorber cited a study published in September 2007 in the
American Journal of Psychiatrythat found rates of suicide
had increased in children and adolescents since the black box
warning was issued. The study, he said, could be an indication that
antidepressants are being underused in kids.
Still, there are very few studies of psychotropic medication use
in very young children. And many doctors aren't comfortable
prescribing the drugs off-label -- in this case, giving medications
to preschoolers that have only been approved for older children or
"I think we have to be really thoughtful about the use of these
medications because we don't really know what they're doing to the
brains of developing children," Froehlich said.
For more on mental health medications, visit the
U.S. National Institute of Mental Health.