Antipsychotic Prescriptions for Children and Adolescents on the Rise in England

A study published in The Lancet Psychiatry found that since 2000, prescriptions for antipsychotics have been increasing among children and adolescents in England.

Researchers from the University of Manchester in the United Kingdom sourced data for this study from the Clinical Practice Research Datalink (CPRD). Children and adolescents (N=7,216,791) aged 3 to 18 years were evaluated for receipt of antipsychotics between 2000 and 2019 in England. In the CPRD, prescriptions are not linked to indications, so 2 psychiatrists independently hypothesized the most likely indications for each drug and together formulated a ranked list of potential antipsychotic indications. Trends over time were evaluated.

The study population comprised 51.8% boys, 25.7% were from the most deprived quintile, and 15.8% the least deprived quintile.

A total of 19,496 (0.3%) adolescents received 243,529 antipsychotic prescriptions for 26 different antipsychotic drugs during the study period. Most patients received atypical antipsychotics (86.2%), specifically risperidone (54.6%), aripiprazole (17.6%), quetiapine (13.8%), or olanzapine (11.3%). Of note, typical antipsychotics were more common in 2000 but by 2019 had decreased by 11.5 times, whereas atypical antipsychotics increased by 6.6 times during the study period.

Overall, the prevalence of antipsychotic prescriptions increased from 0.057% in 2000 to 0.105% in 2019. A joinpoint analysis revealed 4 distinct trends with an average percentage change (APC) of 3.14% between 2000 and 2005, 7.8% between 2005 and 2010, 3.7% between 2010 and 2017, and 6.1% between 2017 and 2019. No significant change in the rate of new prescriptions were observed, whereas average increase in prescriptions per year per patient was 2.2%.

Stratified by patient demographics, the rate of prescriptions for boys was almost twice that of girls and the rate of prescriptions for adolescents aged 15 to 18 years was           twice that of those aged 12 to 14 years and 6 times that of those aged 6 to 11 years. No obvious trends were based on deprivation quintile.

The most common indications for first antipsychotic prescriptions were suspected to be for autism spectrum disorder (12.7%), followed by nonaffective psychosis (8.6%), anxiety disorders (7.5%), attention-deficit/hyperactivity disorder (7.1%), depression (6.4%), and conduct disorders (6.1%). Stratified by gender and age, the most common indications were suspected to be eating disorders for girls (88.2%), attention-deficit/hyperactivity disorder for boys (84.2%), tic disorders for children aged 3 to 11 years (40.4%) and 12 to 14 years (34.1%), and depression for adolescents aged 15 to 18 years (85.1%).

Compared with first antipsychotic prescription, receiving typical antipsychotics compared with atypical antipsychotics decreased with each year of age (adjusted odds ratio [aOR], 0.97) but increased for girls (aOR, 2.12) and those in the least deprived quintile (aOR, 1.53).

The major limitation of this analysis was not having access to data about prescription indication.

Study authors concluded, “From 2000 to 2019, the prescriptions for antipsychotics for children and adolescents in England doubled. […] Authorities in England should monitor and review the emerging trend we describe of broadening clinical indications for antipsychotic use in young people, as well as possible emerging health inequalities in their use. Efficacy and safety evidence should be reassessed and reflected in future guidelines considering the current clinical practices reported here.”

This article originally appeared on Psychiatry Advisor