Academic journal article East Asian Archives of Psychiatry

Prescribing Pattern of Antidepressants in Children and Adolescents: Findings from the Research on Asia Psychotropic Prescription Pattern

Academic journal article East Asian Archives of Psychiatry

Prescribing Pattern of Antidepressants in Children and Adolescents: Findings from the Research on Asia Psychotropic Prescription Pattern

Article excerpt

Introduction

Antidepressant prescription in children and adolescents has gained significant attention in the last decade. Increased utilisation of psychotropic medication for treatment of psychiatric disorders in children and adolescents has previously been comparable with use in adults. (1) The issue of suicidality and selective serotonin reuptake inhibitors (SSRI) first became a public concern when fluoxetine was reportedly associated with suicide in patients. (2) Nonetheless, findings to the contrary have shown that SSRI may be associated with lower suicide rates in children and adolescents (3) and the association with suicide may be invalid. (4-6) As a result of the concerns, prescription of antidepressants to children and adolescents declined. There was a subsequent increase in the rate of completed suicides. (7-9)

Researchers from Europe, the US, and Taiwan have reported antidepressant prescription pattern in children and adolescents. A population-based study from Canada showed growth in the prevalence of antidepressant use among children and adolescents, largely due to an increase in SSRI use. (10) A similar increasing trend of antidepressant prescription among children and adolescents was reported in Spain, Germany, Denmark, the UK, and the Netherlands. (11-13) In the US, the rate of antidepressant use among children and adolescents also showed a rising trend. (14,15) In Taiwan, the 1-year prevalence of antidepressant use in the paediatric population increased from 0.27% in 1997 to 0.47% in 2005. (16)

Data from Asia with regard to antidepressant prescription patterns are lacking. The Research on Asia Psychotropic Prescription Pattern on Antidepressants (REAP-AD) collaborated in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol. Data on antidepressant prescription among children and adolescents (age [less than or equal to] 19 years) were extracted from the main database and analysed in order to understand the pattern of antidepressant use in this age-group.

Methods

Study Sample and Design

The study was part of the REAP project, an international, pharmaco-epidemiological study using a standardised data collection procedure in Asian countries / regions. (17) The study sample comprised 2321 patients from 40 leading psychiatric centres in 10 Asian countries / regions (China, Hong Kong, India, Indonesia, Japan, South Korea, Malaysia, Singapore, Taiwan, and Thailand).

A consensus meeting was held before the study to discuss methodological details, including uniformity of case selection, data collection, and data entry procedures to ensure comparability across sites and countries. Each centre used the same standardised protocol and data collection procedure. The survey was performed from March to June 2013. Information collected from the case records included age, gender, diagnosis, treatment setting, type of antidepressant(s) prescribed and concomitant psychotropics, as well as the dose prescribed by the psychiatrist. The treating psychiatrist completed the survey questionnaire. In this naturalistic study, patients were included if (i) they had been prescribed an antidepressant on the day of survey; (ii) a parent or guardian of the patient could comprehend the aims of the study; and (iii) a parent or guardian of the patient consented to participate in this study, and provided written or oral consent / assent according to the requirements of the clinical research ethics committee in the respective study centre. The clinical research ethics committee of the respective centres granted approval for the study protocol.

The survey settings included outpatient and inpatient facilities. Diagnoses were grouped under major standard ICD-10 categories: organic mental disorders (F0), mental and behavioural disorders due to psychoactive substance use (F1), schizophrenia, schizotypal and delusional disorders (F2), mood disorders (F3), neurotic, stress-related and somatoform disorders (anxiety-related conditions, F4), behavioural syndromes associated with physiological disturbances and physical factors (F5), disorders of adult personality and behaviour (F6), mental retardation (F7), disorders of psychological development (F8), and behavioural and emotional disorders with onset in childhood and adolescence (F9). …

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