Antidepressant and antipsychotic use in an Italian pediatric population

Abstract

BackgroundThe safety and effectiveness of psychotropic drug use in the paediatric population is widely debated, in particular because of the lack of data concerning long term effects.In Italy the prevalence of psychotropic drug prescriptions increased in the early 2000s and decreased afterwards. In such a context, a study with the aim to estimate the incidence and prevalence of psychotropic drug prescription in the paediatric population and to describe diagnostic and therapeutic approaches was performed.MethodsThe study population was composed of 76,000 youths less than 18 years and living in the area covered by the local health unit of Verona, Italy. The data source was the Verona local health unit's administrative prescription database. Prevalence and incidence of antidepressant and/or antipsychotic drug prescriptions in the 2004-2008 period were estimated. Children and adolescents receiving antidepressant and/or antipsychotic drug prescriptions between 1 January 2005 and 31 December 2006 were identified and questionnaires were sent to the prescribers with the aim to collect data concerning diagnostic and therapeutic approaches, and care strategies.ResultsThe prevalence of psychotropic drug prescriptions did not change in the 2004-2008 period, while incidence slightly increased (from 7.0 in 2005 to 8.3 per 10,000 in 2008). Between 1 January 2005 and 31 December 2006, 111 youths received at least one psychotropic drug prescription, 91 of whom received antidepressants. Only 28 patients attended child and adolescent psychiatry services. Information concerning diagnostic and therapeutic approaches, and care strategies was collected for 52 patients (47%). Anxiety-depressive syndrome and attention disorders were the diseases for which psychotropic drugs were most commonly prescribed. In all, 75% youths also received psychological support and 20% were prescribed drugs for 2 or more years.ConclusionsDespite the low drug prescription prevalence, the finding that most children were not cared for by child and adolescent psychiatric services is of concern and calls for a systematic, continuous monitoring of psychopharmacological treatments.

Antipsychotic Use in Children and Adolescents

“…8,9 Specifically, risperidone was the SGA most prescribed in almost all studies on the prevalence of prescriptions in children and adolescents 7,10 as well as in an adolescent inpatient setting, 11 with the exception of 1 study performed in Italy. 12 Moreover, in a prospective study of child and adolescent first episode of psychosis patients (Child and Adolescent First Episode of Psychosis Study), risperidone was the most used AP in nonaffective psychotic patients, whereas olanzapine and quetiapine were more prescribed than risperidone for affective psychosis. 13 Antipsychotic polypharmacy is also an issue in this population, having been reported that the use of combined AP could lead to higher levels of adverse effects.…”

Childhood Depression As Emerging Public Health Problem: A Systematic Review

“…Regarding the selective serotonin reuptake inhibitors (SSRIs), a link between its use and an increased risk of suicidal ideation has been documented in the pediatric population and in youth adults [224,229,230], a fact that ultimately makes the risk-benefit profile for SSRIs not very favorable. The emergence of suicidal thinking and behavior, or unusual changes in behavior should be monitored during the early phases (generally the first 1-2 months) of antidepressant treatment, especially in children, adolescents and young adults between 18 to 24 years old [210].…”

“…The study of claVenna et al [224] highlights that there is a need to define (and to comply with) appropriate diagnostic and therapeutic approaches for child and adolescent psychiatric disorders such as major depressive disorder. The findings showed that the majority of children were not treated in psychiatric services aimed at children and adolescents.…”

“…This finding may at least partly explain the low efficacy of antidepressants. The questions about the safety and effectiveness of psychotropic drug use in the pediatric population are widely debated, in particular because of the lack of data concerning long term effects [224].…”

“…The emergence of suicidal thinking and behavior, or unusual changes in behavior should be monitored during the early phases (generally the first 1-2 months) of antidepressant treatment, especially in children, adolescents and young adults between 18 to 24 years old [210]. Fluoxetine is licensed for major depressive disorder in children over eight years [224] and is the only drug currently licensed to treat depression in children in the United Kingdom as its benefits were deemed greater than its risks [222]. Youth who are adherent to fluoxetine treatment have lower symptom severity over the course of treatment [231].…”