Psychoactive Medication Prescribing Practices for U.S. Children: Gaps Between Research and Clinical Practice

Jensen, Peter S.; Bhatara, Vinod S.; Vitiello, Benedetto; Hoagwood, Kimberly; Feil, Michael; Burke, Laurie B.

doi:10.1097/00004583-199905000-00017

Cited by 245 publications

(148 citation statements)

References 31 publications

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“…Although ADHD may often have comorbid psychiatric disorders, the use of SSRIs for the single diagnosis of ADHD has very little research support. 2,6 The entry of SSRIs into this arena may complicate the ongoing debate about the wide variation in treatment. 17,23 Attention must also be paid to the finding that 40% of respondents have prescribed an SSRI in combination with other psychotropic medications.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Fluoxetine, paroxetine, and sertraline prescriptions for preschool-and school-aged children tripled between 1993 and 1997. 3 Emerging clinical experience, case reports, and research trials indicate promising results for children and adolescents with depression, obsessive-compulsive disorder, and other psychiatric illnesses.…”

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confidence: 99%

“…9 -11 Second, although SSRIs have a good safety profile in general, SSRIs have a variety of documented side effects in adults and children, and the long-term effects of many psychoactive drugs on the developing pediatric central nervous system are unknown. 2,4,12 Finally, although clinical trials have demonstrated benefit for some disorders, long-term outcomes are unknown and may prove suboptimal if SSRIs alone replace multimodal therapy including behavioral and counseling interventions. 6 Family physicians and pediatricians care for many patients with mental health needs in the primary care setting without referral to a psychiatrist or specialist.…”

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confidence: 99%

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Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

2000

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ABSTRACT. Objectives. Selective serotonin reuptake inhibitor (SSRI) prescriptions for children and adolescents have increased greatly in recent years despite a paucity of demonstrated safety and efficacy data and a lack of clear guidelines for use. Our study sought to describe family physician and pediatrician SSRI prescribing patterns for children and adolescents, identify influences on SSRI prescription variations, and describe the use of SSRI within the overall management of depression and other mental disorders in primary care.Design. A survey was mailed to all 596 active North Carolina general pediatricians and a random sample of 557 family physicians in primary care practice. Family physicians who did not see children in their practice were excluded. The survey instrument consisted of a 4-page questionnaire. Survey items included physician demographics, practice characteristics, general management, volume of pediatric patients with depressive symptoms, prescription of SSRIs for depression and other diagnoses, and potential influences on SSRI prescribing practices. The main outcomes were self-reported physician prescription of SSRIs for children and adolescents. Results were analyzed using 2 comparisons and logistic regression.Results. The overall response rate was 66% (55% family physicians and 76% pediatricians). Of the physicians, 72% had prescribed an SSRI for a child or adolescent. Depression was the most common reason for prescribing an SSRI; over two thirds of respondents had prescribed an SSRI for depression in a child 18 years of age or younger. Over half of the physicians reported they had prescribed an SSRI for a diagnosis other than depression in a child 18 years of age or younger. Attention-deficit/ hyperactivity disorder was the most frequent use cited other than depression, followed by obsessive-compulsive disorder, aggression, eating disorders, and enuresis.Primary care physicians prescribed SSRIs for adolescents more commonly than for younger children. Only 6% of the respondents had ever prescribed an SSRI for a child younger than 6 years of age. In terms of SSRI prescriptions written for depression in the last 6 months, 32% of the physicians had recently prescribed SSRIs for adolescent patients and 6% for patients younger than 12 years of age. Family physicians were more likely than pediatricians to have recently prescribed SSRIs for adolescent patients (41% vs 26%), but there was no difference in recent SSRI prescriptions for children <12 years of age by physician specialty (4% vs 6%).Prescription of SSRIs was not associated with decreased use of counseling for treatment of depression, but prescription of SSRIs was associated with decreased use of referrals (63% vs 74%). There was no difference in the use of counseling between family physicians and pediatricians (61% vs 59%). However, pediatricians were more likely to use referrals in their usual approach to depression (77% vs 48%) compared with family physicians.More family physicians had prescribed SSRIs for pediatric patients compared ...

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Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

2000

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“…In contrast, the increasing off-label use of psychotropics in children, coupled with the lack of adequate data to support their efficacy and safety, was eventually recognized as an important public health issue to be addressed through research in both the U.S. (Vitiello & Jensen, 1997;Jensen et al 1999) and Europe (Fegert 2003). In spite of the orphan drug regulations in Europe since 2001 until now (see below), 51 drugs or application modifications have been licensed.…”

Section: Pharmacologic Randd For Minorsmentioning

confidence: 99%

Children in Need of Medical Innovation

2004

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“…Le taux annuel de prescription de psychotropes chez les enfants et les adolescents aux États-Unis a commencé à augmenter au milieu des années 1990 avec une forte accélération après 1999 [1]. Les stimulants (méthylphénidate) et les inhibiteurs de recapture de la sérotonine sont les plus fréquemment consommés par les moins de 18 ans [2]. Entre 1993 et 2002, le nombre de consultations avec prescriptions d'antipsychotiques pour les jeunes a été multiplié par six [3].…”

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2009

Med Sci (Paris)

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Psychoactive Medication Prescribing Practices for U.S. Children: Gaps Between Research and Clinical Practice

Cited by 245 publications

References 31 publications

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

Children in Need of Medical Innovation

La pédopsychiatrie américaine au ban des accusés

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