A multi-national comparison of antipsychotic drug use in children and adolescents, 2005-2012

Over the last decades, an increase in antipsychotic (AP) prescribing and a shift from first-generation antipsychotics (FGA) to second-generation antipsychotics (SGA) among youth have been reported. However, most AP prescriptions for youth are off-label, and there are worrying long-term safety data in youth. The objective of this study was to assess multinational trends in AP use among children and adolescents. A repeated cross-sectional design was applied to cohorts from varied sources from Denmark, Germany, the Netherlands, the United Kingdom (UK) and the United States (US) for calendar years 2005/2006-2012. The annual prevalence of AP use was assessed, stratified by age group, sex and subclass (FGA/SGA). The prevalence of AP use increased from 0.78 to 1.03% in the Netherlands' data, from 0.26 to 0.48% in the Danish cohort, from 0.23 to 0.32% in the German cohort, and from 0.1 to 0.14% in the UK cohort. In the US cohort, AP use decreased from 0.94 to 0.79%. In the US cohort, nearly all ATP dispensings were for SGA, while among the European cohorts the proportion of SGA dispensings grew to nearly 75% of all AP dispensings. With the exception of the Netherlands, AP use prevalence was highest in 15-19 year-olds. So, from 2005/6 to 2012, AP use prevalence increased in all youth cohorts from European countries and decreased in the US cohort. SGA were favoured in all countries' cohorts

Study population characteristics by antidepressant (AD).

<p>Values are numbers (column percentages) unless otherwise indicated.</p><p>SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; MAOI = mono-amine oxidase inhibitor; other ADs are: mirtazapine, venlafaxine, flupentixol, duloxetine, nefazodone and reboxetine.</p

Annual percentage change (APC) for selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) as groups and individual drugs.

*<p>Annual percentage change (APC) is statistically significant (p<0.05) different from 0.</p>1<p>Observations start in 1999 for citalopram as prescription rates were negligible (<10 prescriptions a year) before this year.</p>2<p>Observations stop in 2005 for paroxetine as it is only prescribed sporadically (<5 prescriptions a year) after this time point.</p>3<p>Observations start in 1996 for sertraline as prescription rates were negligible (<10 prescriptions a year) before this year.</p

Incidence rate ratios (IRR) for diagnosis and symptoms of depression and antidepressant prescriptions stratified by gender, age group and deprivation.

a<p>Adjusted for calendar year, gender, deprivation, age and for clustering by general practitioner practice using robust standard errors.</p>b<p><i>P</i> based on Wald test.</p>c<p>A Townsend score of 1 or 2 represents the most affluent patients, while patients with a Townsend score of 4 or 5 live in the most deprived areas.</p

Trends in ADHD medication use in children and adolescents in five western countries, 2005-2012

Over the last two decades, the use of ADHD medication in US youth has markedly increased. However, less is known about ADHD medication use among European children and adolescents. A repeated cross-sectional design was applied to national or regional data extracts from Denmark, Germany, the Netherlands, the United Kingdom (UK) and the United States (US) for calendar years 2005/2006-2012. The prevalence of ADHD medication use was assessed, stratified by age and sex. Furthermore, the most commonly prescribed ADHD medications were assessed. ADHD medication use prevalence increased from 1.8% to 3.9% in the Netherlands cohort (relative increase: +111.9%), from 3.3% to 3.7% in the US cohort (+10.7%), from 1.3% to 2.2% in the German cohort (+62.4%), from 0.4% to 1.5% in the Danish cohort (+302.7%), and from 0.3% to 0.5% in the UK cohort (+56.6%). ADHD medication use was highest in 10-14-year olds, peaking in the Netherlands (7.1%) and the US (8.8%). Methylphenidate use predominated in Europe, whereas in the US amphetamines were nearly as common as methylphenidate. Although there was a substantially greater use of ADHD medications in the US cohort, there was a, relatively greater increase in ADHD medication use in youth in the four European countries. ADHD medication use patterns in the US differed markedly from those in western European countries. (C) 2017 Elsevier B.V. and ECNP. All rights reserved