I encounter a lot of people who think that too many American kids are on psychiatric medications. It's a position that's hard to argue with, given that I am routinely referred patients who are on 3, 4, sometimes 5 or more different psychotropic medications. A new study that was published in the journal Child and Adolescent Psychiatry and Mental Health, suggests that American kids are more medicated than European kids. The evidence from this study shows that US children are 3 times more likely than European children to be prescribed psychiatric medications.
The study looked at administrative claims data for the year 2000 from 356,520 children and adolescents in Germany, 110,944 in the Netherlands, and 127,157 from the United States. Of these children and teenagers, 6.7% of the US group, 2.0% of the German group, and 2.9% of the Netherlands group were on a psychiatric medication. Compared to children living in Germany and the Netherlands, American kids were 3 times more likely to be prescribed stimulants and antidepressants and 1.5 to 2.2 times more likely to be prescribed antipsychotic medications.
Julie Zito and colleagues identified several reasons why this may be. For one, there is a trend in the United States of increased bipolar disorder diagnosis in children and teenagers. Direct-to-consumer advertising is commonplace in the United States. There is a difference in diagnostic systems in Europe. US psychiatrists tend to use the Diagnosis and Statistic Manual while European physicians tend to use the International Classification of Diseases. The US also have a larger number of child psychiatrists per capita than most European nations. Also, there are specific cost restrictions in Europe that do not apply in the United States as well as different reimbursement policies which may limit the prescribing of some of the more expensive medications. Lastly, the group suggested that there are specific cultural differences in the role that medications can play in treatment of emotional and behavioral disturbances.
I present this information not to scare a parent whose child is on a psychiatric medication but to urge questioning. Children are more likely to have serious side effects from medications than adults, so it's important that parents have a good understanding of what the medications that have been prescribed are supposed to do. Here are some basic points to know if a doctor suggests your child needs psychiatric medications:
• What is the diagnosis for which you are prescribing the medication?
• How likely is it that the medication will help my child with his or her symptoms?
• What are the side effects that my child is likely to experience?
• Are there any alternatives to the medication you are prescribing, for example talk therapy?
This is not a comprehensive list, but it is some basic questions that every doctor should be able to answer, and hopefully will start a more detailed discussion as to how best to treat your child so he or she is not overmedicated.