Trends in Use of Antidepressants, Lithium, and Anticonvulsants in Kaiser Permanente-Insured Youths, 1994–2003

Hunkeler, Enid M.; Fireman, Bruce; Lee, Janelle; Diamond, Robert; Hamilton, John D.; He, Cheyenne X.; Dea, Robin; Nowell, W. Benjamin; Hargreaves, William A.

doi:10.1089/cap.2005.15.26

Cited by 45 publications

(28 citation statements)

References 40 publications

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“…Some of the most frequently reported symptoms of pediatric bipolar disorder such as distractibility, pressured speech, and irritability 17 overlap with ADHD symptoms. In addition, the expanding use of secondgeneration antipsychotic medications 4,45 and mood stabilizers 3,46 to treat aggressive and effectively labile youth may have also contributed to a shift toward diagnosis of child and adolescent bipolar disorder.…”

Section: Commentmentioning

confidence: 99%

National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth

Moreno

Laje²,

Blanco³

et al. 2007

Arch Gen Psychiatry

607

331

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Although bipolar disorder may have its onset during childhood, little is known about national trends in the diagnosis and management of bipolar disorder in young people.Objectives: To present national trends in outpatient visits with a diagnosis of bipolar disorder and to compare the treatment provided to youth and adults during those visits.Design: We compare rates of growth between 1994-1995 and 2002-2003 in visits with a bipolar disorder diagnosis by individuals aged 0 to 19 years vs those aged 20 years or older. For the period of 1999 to 2003, we also compare demographic, clinical, and treatment characteristics of youth and adult bipolar disorder visits.Setting: Outpatient visits to physicians in office-based practice.Participants: Patient visits from the National Ambulatory Medical Care Survey (1999)(2000)(2001)(2002)(2003) with a bipolar disorder diagnosis (n = 962).Main Outcome Measures: Visits with a diagnosis of bipolar disorder by youth (aged 0-19 years) and by adults (aged Ն20 years). Results:The estimated annual number of youth office-based visits with a diagnosis of bipolar disorder increased from 25 (1994)(1995) to 1003 (2002-2003) visits per 100 000 population, and adult visits with a diagnosis of bipolar disorder increased from 905 to 1679 visits per 100 000 population during this period. In 1999 to 2003, most youth bipolar disorder visits were by males (66.5%), whereas most adult bipolar disorder visits were by females (67.6%); youth were more likely than adults to receive a comorbid diagnosis of attention-deficit/hyperactivity disorder (32.2% vs 3.0%, respectively; P Ͻ .001); and most youth (90.6%) and adults (86.4%) received a psychotropic medication during bipolar disorder visits, with comparable rates of mood stabilizers, antipsychotics, and antidepressants prescribed for both age groups.Conclusions: There has been a recent rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings. This increase highlights a need for clinical epidemiological reliability studies to determine the accuracy of clinical diagnoses of child and adolescent bipolar disorder in community practice.

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Section: Commentmentioning

confidence: 99%

National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth

Moreno

Laje²,

Blanco³

et al. 2007

Arch Gen Psychiatry

607

331

View full text Add to dashboard Cite

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“…For largely commercial reasons, valproate has largely replaced lithium as the first-line therapy for bipolar disorder in the United States [33,34]. Despite such widespread use, valproate has not been nearly as well studied as lithium for treatment of bipolar I depression [5•].…”

Section: Valproatementioning

confidence: 99%

Pharmacotherapy of bipolar depression: An update

Thase

2006

Curr Psychiatry Rep

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Bipolar affective disorder is a virulent illness with high rates of recurrence, disability, social impairment, and suicide. Although the manic or hypomanic episodes define the disorder, the depressions are more numerous and less responsive to treatment. As the initial depressive episodes are commonly misdiagnosed, initiation of therapy with mood stabilizers is often delayed, increasing the likelihood of treatment-emergent affective switches on antidepressant monotherapy. The empirical basis for selecting treatments for people with bipolar depression is weak, and only the combination of olanzapine and fluoxetine has received US Food and Drug Administration (FDA) approval. Conventional mood stabilizers are preferred for first-line therapies, although atypical antipsychotics are increasingly used, and FDA approval of quetiapine is pending. Antidepressants--particularly selective serotonin reuptake inhibitors and bupropion--are indicated when mood stabilizers are ineffective and for "breakthrough" depressions.

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“…[16][17][18] Antipsychotic use increased from 8.6 per 1000 children to 39.4 per 1000 children from 1995 to 2002, for example, and antidepressant use increased from 9.4 per 1000 to 21.3 per 1000 children between 1994 and 2003. [19][20][21] The lack of clinical evidence to support the use of these agents in children has resulted in a number of controversies, including concerns over increased suicidality among adolescents treated with selective serotonin reuptake inhibitors and of antipsychotic side effects in young children. [22][23][24][25] We define the current state of pediatric research activity for neuropsychiatric disease, including the underrepresentation of certain drug classes and conditions.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Pediatric Clinical Drug Trials for Neuropsychiatric Conditions

2013

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BACKGROUND AND OBJECTIVE: Neuropsychiatric conditions represent a large and increasing disease burden in children. A number of drugs are available for the treatment of these conditions, but most drugs have not been adequately tested in children, and off-label drug use remains widespread. We sought to define and quantify recent and ongoing clinical research on the use of neuropsychiatric drugs in children. METHODS: Drug trials registered in ClinicalTrials.gov between 2006 and 2011 and studying neuropsychiatric conditions were selected and classified based on the drug’s Food and Drug Administration (FDA) approval status in children. We measured the proportion of trials seeking to expand the use of a drug to pediatric patients and the proportion of available drugs studied in children. RESULTS: Only 10% of neuropsychiatric trials focused on children. Of 303 drugs studied in both pediatric and adult populations, 90% lacked FDA approval in children and 97% were not approved in children for the indication studied. However, only 19% of all neuropsychiatric drugs were under study in pediatric populations, with as few as 8% of either antidepressant or antipsychotic drugs. Overall, 76% of pediatric drug trials examined a drug previously unapproved in children and 26% explored the use of a drug for a new indication. CONCLUSIONS: Despite the rising prevalence of neuropsychiatric disease and the paucity of FDA-approved pediatric drugs, only a small proportion of trials focus on pediatric populations and these trials cover only a fraction of available drugs. This deficiency is most pronounced for depression and schizophrenia.

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Trends in Use of Antidepressants, Lithium, and Anticonvulsants in Kaiser Permanente-Insured Youths, 1994–2003

Cited by 45 publications

References 40 publications

National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth

National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth

Pharmacotherapy of bipolar depression: An update

Analysis of Pediatric Clinical Drug Trials for Neuropsychiatric Conditions

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