Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

Abstract

It is estimated that 8% to 12% of youth are prescribed psychotropic medications. Those in foster care, juvenile justice systems, residential treatment facilities, and with developmental or intellectual disabilities are more likely to be prescribed high-risk regimens. The use of psychotropic medications in this age group is often off-label and can be associated with significant risk, warranting critical evaluation of their role. Landmark trials, pediatric-specific guidelines, and state-driven initiatives play critical roles in supporting evidence-based use of psychotropic medications in children. Overall, there is a lack of literature describing the long-term use of psychotropic medications in youth—particularly with regard to neurobiological, physical, and social changes that occur throughout development. Deprescribing is an important practice in child and adolescent psychiatry, given concerns for over-prescribing, inappropriate polytherapy, and the importance of reevaluating the role of psychotropic medications as children develop.

Role of Board‐Certified Psychiatric Pharmacists in child and adolescent psychiatry

“…It is estimated that 8%-12% of children and adolescents are prescribed psychotropic medications, with stimulants, nonstimulants (i.e., alpha-2 agonists), antidepressants, and atypical antipsychotics among those most frequently prescribed. 13 Neurobiologic changes during childhood, pediatric-specific risk for adverse effects, and developmental considerations (e.g., physical development) warrant thorough evaluation of psychotropic medication use in this patient population. 13 Vulnerable populations are prescribed psychotropic medications at even higher rates.…”

“…13 Neurobiologic changes during childhood, pediatric-specific risk for adverse effects, and developmental considerations (e.g., physical development) warrant thorough evaluation of psychotropic medication use in this patient population. 13 Vulnerable populations are prescribed psychotropic medications at even higher rates. Children and adolescents in foster care, juvenile justice systems, and with developmental or intellectual disabilities are the most likely to be prescribed high-risk psychotropic medication regimens (e.g., >1 agent from the same pharmacologic class, ≥ 3 concomitant psychotropic medications).…”

“…Children and adolescents in foster care, juvenile justice systems, and with developmental or intellectual disabilities are the most likely to be prescribed high-risk psychotropic medication regimens (e.g., >1 agent from the same pharmacologic class, ≥ 3 concomitant psychotropic medications). 13,14 Not only are 13%-31% of youth in foster care prescribed at least one psychotropic medication, but they are four times as likely to be prescribed at least three psychotropic medications and twice as likely to be prescribed at least one concomitant antipsychotic as those, not in foster care. 15,16 Children and adolescents experienced disproportionate harm to their mental health during the coronavirus disease 2019 (COVID- 19) pandemic.…”

“…1 Board-Certified Psychiatric Pharmacists work in a variety of unique pediatric settings, including children's hospital psychiatric pavilions, ambulatory clinics, and psychiatric hospitals, and work with diverse CAP patient populations (Table 1). 8,10,[12][13][14][15]17,18,[20][21][22][23][24][25][26][27][28][29][30][31] Where properly integrated, BCPPs are viewed as valuable members of the CAP team by CAP, pediatricians, and foster care social workers, among others. 4,10,15,32 Through implementation of CMM, BCPPs address pediatric polypharmacy, increase medication adherence and knowledge, and enhance patient outcomes.…”

“…Landmark trials, pediatric-specific guidelines, state-driven initiatives, and regulatory standards aim to support the evidence-based use of psychotropic medications in children and adolescents. 13 Collaborative decision-making among the treatment team, patients, and their caregivers is also essential and should include a review of short-and longterm benefits, risks, treatment goals, target symptoms, and expected duration of treatment. Board-Certified Psychiatric Pharmacists in CAP can broadly support the use of psychotropic medications in children and adolescents with a variety of mental health conditions (Table 1), and regulatory standards are of a critical point of focus (Table 2).…”