From Our 2012 Archives
Mood-Altering Medications Not Overused in Teens
By Brenda Goodman, MA
Reviewed by Louise Chang, MD
Dec. 3, 2012 -- Most teens with mental illnesses don't take medications for their conditions, a new survey finds.
The study contradicts reports of widespread and indiscriminate pill-popping in high schoolers. If anything, researchers say, many kids may not be getting enough help for real problems that are affecting their lives.
"The one thing that we heard over and over when we started this study was that parents are getting their kids prescriptions for stimulants so they can do better on the SATs," says researcher Kathleen Merikangas, PhD, chief of the genetic epidemiology branch in the intramural research program at the National Institute of Mental Health in Bethesda, Md.
But researchers, who questioned teens for the study, say they found no evidence of that trend.
"I was surprised that the rates were as low as they were. I thought the frequency of medication use was lower than we would have expected," Merikangas says.
She points out that not treating mental health problems in teens can often lead to serious problems. They include failing grades, disruptive or criminal behavior, substance abuse, and suicide.
"As a society, we need to think about access to care before all of these bad outcomes occur," Merikangas says.
Psychiatric Medications in Teens
Previous studies have relied on insurance claims to estimate rates of medication use in children and teens. Those studies have found sharp rises with psychiatrists prescribing to kids, especially poor children.
One 2006 study found that prescriptions of psychotropic drugs written to teens had shot up 250% between 1994 and 2001. It's not always clear from claims data why the drugs are prescribed or even if they're taken.
The new study, published in the Archives of Pediatric and Adolescent Medicine, took a different approach.
Researchers surveyed more than 10,000 teens in the U.S. who were between the ages of 13 and 18. The teens were carefully selected to reflect the makeup of the general population.
Researchers interviewed the teens at home and asked about any symptoms of mental problems in the past year that had been severe enough to affect their day-to-day functioning. When they reported taking medications, researchers had them produce the pill bottle so they could write down the drug name.
About half the teens in the study met the criteria for a mental disorder, and 22% were classified as being severely affected by their problems.
Despite that, only 14.1% of kids had taken any kind of psychotropic drug. The highest rates of medication use were in kids who met the criteria for attention deficit hyperactivity disorder (ADHD). Nearly 1 in 3 kids with ADHD reported taking a psychotropic medication. About 1 in 5 had been prescribed stimulants to help manage their condition.
In contrast, teens who were anxious, depressed, or bipolar were less likely to be prescribed a drug that could help. About 11% of teens diagnosed with an anxiety disorder were prescribed medications. About 20% of kids with depression or bipolar disorder were taking a mood-altering medication.
The study also found that the majority of kids who had been prescribed a psychotropic drug had a mental disorder severe enough to disrupt their day-to-day lives.
Many Kids Need Better Mental Health Care
"Not only were they not overprescribed, one could say that this group was inadequately treated," says Victor Fornari, MD, director of the division of child and adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, N.Y.
Fornari, who wasn't involved in the research, praised the study for its careful methods. He says it reflects attitudes he often sees in his own practice.
"There's enormous resistance. Many families, maybe 50%, refuse treatment, even when they are told their child has a psychiatric disorder," Fornari tells WebMD.
Health coverage may be another factor behind the lower-than-expected rates of medication use seen in teens.
In an editorial on the study, David Rubin, MD, a pediatrician at the Children's Hospital of Philadelphia, points out that many middle-class families simply can't afford mental health care. These teens are often covered on their parents' private insurance plans, which rarely cover mental health visits.
"The take-home message is that as a country it should bother us that many children do not have access to the appropriate services they need, and that rates of medication use (whether high or low) are really a symptom of a mental health system that does not meet the standard of what any parent -- whether rich or poor -- would hope for their children if they were in crisis," Rubin says.
SOURCES: Merikangas, K. Archives of Pediatric and Adolescent Medicine, Dec. 4, 2012. Rubin, D. Archives of Pediatric and Adolescent Medicine, Dec. 4, 2012. Kathleen Merikangas, PhD, chief, Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Md. Victor Fornari, MD, Director, Division of Child/Adolescent Psychiatry, North Shore-LIJ Health System, New Hyde Park, N.Y. David Rubin, MD, associate professor, pediatrics, Children's Hospital of Philadelphia, Philadelphia, Penn.
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