The use of stimulants and antidepressants in preschool children in the United States is increasing, according to a study reported this week in the Journal of the American Medical Association (2000;283: 1025). Researchers from Baltimore, US, studied the prescription records of children aged two to four years enrolled in three separate health care programmes to determine the prevalence of psychotropic drug use. Psychotropic medication was defined as such drugs as stimulants, antidepressants, sedatives and antipsychotic drugs that have an effect on the mind. The researchers analysed data from 1991, 1993 and 1995 from more than 200,000 patients.
"Overall, there were large increases for all study medications (except neuroleptics)," say the authors. Increases were noted between 1991 and 1995 across the three sites for stimulants, antidepressants and clonidine. In 1995, the prevalence rates per 1,000 two- to four-year-olds in the Midwestern state Medicaid programme were 12.3 for stimulants, 3.2 for antidepressants and 2.3 for clonidine; the figures were lower in the other two health care programmes. For methylphenidate, a nervous system stimulant, a three-fold increase was seen at two of the sites examined. The authors note that most psychotropic medication prescriptions for preschool children are used off-label.
In an accompanying editorial (ibid, p1059) additional concerns are offered by Dr Joseph Coyle (Harvard Medical School, Boston). "It appears that behaviourally disturbed children are now increasingly subjected to quick and inexpensive pharmacologic fixes as opposed to informed, multimodal therapy associated with optimal outcomes," comments Dr Coyle. He adds: "Given that there is no empirical evidence to support psychotropic drug treatment in very young children and that there are valid concerns that such treatment could have deleterious effects on the developing brain, the reasons for these troubling changes in practice need to be identified."