Most teens with mental disorders not on medication: study

Despite concerns that too many US young people are using prescription psychiatric drugs, a US study said that just one in seven teens with a mental disorder has been prescribed medication.

Researchers from the National Institutes of Health (NIH), which funded the study, said there was no compelling evidence for either misuse or overuse of psychotropic medications, which include stimulants for attention-deficit hyperactivity disorder (ADHD), antidepressants and antipsychotics.

“Certain the use of psychiatric medications has been increasing in children and adolescents over the years,” said Benedetto Vitiello from the NIH, who worked on the study.

“(But) most of the adolescents who met the criteria for a condition were not receiving medication, which suggests that they were being treated with something else, maybe psychotherapy, or maybe they were not even treated,” he added.

“This data may suggest that there may be underuse (of psychiatric medications) in some cases.”

The findings, which appeared in the Archives of Pediatrics & Adolescent Medicine, are based on interviews with more than 10 000 teens and their parents, most of whom had at least a high school education and were middle class or above. The interviews were conducted between 2001 and 2004.

Vitiello and his colleagues found 2 350 teens had any type of mental disorder, including anxiety, eating disorders, depression and ADHD.

Just over 14% of youth with a mental disorder had been prescribed a psychiatric drug in the past year. That varied by drug and type of disorder: one in five teens with ADHD was recently prescribed stimulants, for example, compared to one in 22 with anxiety who were on an antidepressant.

In youth without signs of a current disorder, 2,5% had been prescribed a psychiatric drug recently — most of whom had some signs of distress or a past mental disorder, the researchers said.

The study did not keep track of how many teens were taking drugs they weren’t prescribed, such as misusing stimulants as study aids.

Because the interviews were conducted in the early 2000s, the findings may not mirror current trends in prescribing to youth, the researchers warned.

In addition, the report includes a disproportionate number of children from high income families, said David Rubin, from Children’s Hospital in Philadelphia, who wrote a commentary on the report.

Children on Medicaid, the government-sponsored health insurance program for the poor, tend to take more psychiatric drugs. That’s especially true among the smaller subset of youth in foster care, of whom 12% were prescribed antipsychotics in 2007, according to Rubin’s past research.

Medicaid enrollees get mental health services for free, but where they can access them, those services are often skewed toward medication instead of talk therapy, Rubin said.

For middle-class youth, insurance co-pays may present more of a barrier to any type of care, including medication.

“The concern regarding the overtreatment versus undertreatment of mental health conditions is really a difficult problem to answer,” said Robert Fortuna from the University of Rochester Medical Center.

“It really requires a more nuanced view that we are possibly overprescribing in some situations and missing opportunities to treat in other situations.”