Skip to main content
SpringerLink
Log in

Use of psychotropic medications in Italian children and adolescents

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Introduction

The evidence of psychotropic drug safety and efficacy in the pediatric population is scant and widely debated. Yet, the prescription prevalence and incidence are increasing. A drug utilization study, based on a multiregional prescription database was therefore carried out in a sample of 1,484,770 Italian children and adolescents younger than 18 years during the year 2004. Furthermore, the trend of psychotropic prescription prevalence was evaluated from 1998 to 2004. During 2004, 4,316 children and adolescents received psychotropic drugs (2.91‰ youths). Antidepressants were prescribed to 3,503 youths (2.36‰), antipsychotics to 1,005 (0.68‰), and lithium to 73 (0.05‰). A total of 265 youths received drugs from more than one psychotropic class. The prevalence rate of psychotropic drug prescriptions increased with increasing age, with a statistically significant trend (\(\chi ^{2}_{t} = 2443\); p<0.0001), and it increased in the period 1998–2004 with a statistically significant trend (\( \chi ^{2}_{t} = 298 \); p<0.0001), reaching its highest value in 2002 (3.08‰). The trend for antidepressants was similar (\( \chi ^{2}_{t} = 501 \); p<0.0001), while the prevalence of antipsychotics did not increase.

Conclusion

Even though the prevalence of psychotropic drug prescriptions in Italian children is lower than that reported in other countries (e.g. United States, Canada, Netherlands, UK), the increase in antidepressant prescriptions raises some concerns. Data concerning safety and efficacy of these antidepressants in pediatrics are still limited and further studies are needed to guarantee evidence based therapeutic approaches in children, adolescents and their families.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ATC:

anatomic therapeutic chemical

CINECA:

Interuniversity Consortium

FDA:

Food and Drug Administration

MDD:

major depressive disorder

OCD:

obsessive compulsive disorder

SSRI:

selective serotonin reuptake inhibitor

TCA:

tricyclic antidepressant

References

  1. Abi Khaled L, Ahmad F, Brogan T, Fearnley J, Graham J, MacLeod S, McCormick J (2003) Prescription medicine use by one million Canadian children. Paediatrics Child Health 8(Suppl A):34A–42A

    Google Scholar 

  2. Aman MG, De Smedt GD, Derivan A, Lyons B, Findling RL (2002) Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence. Am J Psichiatry 159:1337–1346

    Article  Google Scholar 

  3. American Academy of Child and Adolescent Psychiatry (1998) Practice parameters for the assessment and the treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 37(10S):27S–45S

    Google Scholar 

  4. Ansorge MS, Zhou M, Lira A, Hen R, Ginrich JA (2004) Early-life blockade of the 5-HT transporter alters emotional behavior in adult mice. Science 306:879–881

    Article  PubMed  CAS  Google Scholar 

  5. Bennett K, Teeling M, Feely J (2005) Overprescribing antidepressants to children: pharmacoepidemiological study in primary care. BMJ 331:1451–1452

    Article  PubMed  Google Scholar 

  6. Berard R, Fong R, Carpenter DJ, Thomason C, Wilkinson C (2006) An international, multicenter, placebo-controlled trial of paroxetine in adolescents with major depressive disorder. J Child Adolesc Psychopharmacol 16:59–75

    Article  PubMed  Google Scholar 

  7. Bonati M, Clavenna A (2005) The epidemiology of psychotropic drug use in children and adolescents. Int Rev Psychiatry 17:181–188

    Article  PubMed  CAS  Google Scholar 

  8. Brooks SJ, Kutcher S (2003) Diagnosis and measurement of anxiety disorder in adolescents: a review of commonly used instruments. J Child Adolesc Psychopharmacol 13:351–400

    Article  PubMed  Google Scholar 

  9. Casper RC, Fleisher BE, Lee-Ancajas JC, Gilles A, Gaylor E, De Battista A, Hoyme HE (2003) Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy. J Pediatr 142:402–408

    Article  PubMed  CAS  Google Scholar 

  10. Cheng-Shannon J, McGough JJ, Pataki C, McCracken JT (2004) Second-generation antipsychotic medications in children and adolescents. J Child Adolesc Psychopharmacol 14:372–394

    Article  PubMed  Google Scholar 

  11. Clavenna A, Bonati M (2006) Epidemiological aspects of drug use. In: Jacqz-Aigrain E, Choonara I (eds) Paediatric Clinical Pharmacology. Taylor & Francis, New York, pp 73–83

    Google Scholar 

  12. Clavenna A, Bonati M, Rossi E, De Rosa M (2004) Increase in non-evidence based use of antidepressants in children is cause for concern. BMJ 328:711–712

    Article  PubMed  Google Scholar 

  13. Committee on Safety of Medicines (2003) Selective serotonin reuptake inhibitors—use in children and adolescents with major depressive disorder. Available at http://www.info.doh.gov.uk/doh/embroadcast.nsf/0/183a970c6d74afad80256df800330c99/\$FILE/CEM2003-20.doc. Accessed 5 May 2006

  14. Coyle JT (2000) Psychotropic drug use in very young children. JAMA 283:1059–1060

    Article  PubMed  CAS  Google Scholar 

  15. Delate T, Gelenberg AJ, Simmons VA, Motheral BR (2004) Trends in the use of antidepressants in a national sample of commercially insured pediatric patients, 1998 to 2002. Psychiatric Services 55:387–391

    Article  PubMed  Google Scholar 

  16. Duff G (2003) Safety of seroxat (paroxetine) in children and adolescents under 18 years—contraindication in the treatment of depressive illness. Available at: http://www.mhra.gov.uk/home/groups/plp/documents/drugsafetymessage/con019507.pdf. Accessed 5 May 2006

  17. Efron D, Hiscock H, Sewell JR, Cranswick NE, Vance ALA, Tyl Y, Luk ESL (2003) Prescribing of psychotropic medications for children by Australian pediatricians and child psychiatrists. Pediatrics 111:372–375

    Article  PubMed  Google Scholar 

  18. EMEA (2005) European Medicines Agency finalises review of antidepressants in children and adolescents. Available at: http://www.emea.eu.int/pdfs/human/press/12891805en.pdf. Accessed 5 May 2006

  19. Emslie GJ, Wagner KD, Kutcher S, Krulewicz S, Fong R, Carpenter DJ, Lipschitz A, Machin A, Wilkinson C (2006) Paroxetine treatment in children and adolescents with major depressive disorder. A randomized, multicenter, double-blind, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry 45:6 (in press)

    Article  Google Scholar 

  20. Food and Drug Administration (2004) Public Health Advisory. Suicidality in children and adolescents being treated with antidepressant medications. Available at http://www.fda.gov/cder/drug/antidepressants/SSRIPHA200410.htm. Accessed 5 May 2006

  21. Food and Drug Administration (2003) FDA Talk Paper. FDA approves Prozac for pediatric use to treat depression and OCD. Available at http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01187.html. Accessed 5 May 2006

  22. Food and Drug Administration (2003) FDA Talk Paper. FDA statement regarding the anti-depressant Paxil for pediatric population. Available at: http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01203.html. Accessed 5 May 2006)

  23. Fegert JM, Kölch M, Magno Zito J, Glaeske G, Janhsen K (2006) Antidepressant use in children and adolescents in Germany. J Child Adolesc Psychopharmacol 16:197–206

    Article  PubMed  Google Scholar 

  24. Geller DA, Biederman J, Stewart SE, Mullin B, Martin A, Spencer T, Faraone SV (2003) Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive compulsive disorder. Am J Psychiatry 160:1919–1928

    Article  PubMed  Google Scholar 

  25. Hammad TA, Laughren T, Racoosin J (2006) Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 63:332–339

    Article  PubMed  CAS  Google Scholar 

  26. Hazell P, O’Connell D, Heathcote D, Henry D (2002) Tricyclic drugs for depression in children and adolescents. The Cochrane database of systematic reviews, issue 2, article no.: CD002317. DOI 10.1002/14651858.CD002317. Accessed 5 May 2006

  27. Jureidini JN, Doecke CJ, Mansfield PR, Haby MM, Menkes DB, Tonkin AL (2004) Efficacy and safety of antidepressants for children and adolescents. BMJ 328:879–883

    Article  PubMed  CAS  Google Scholar 

  28. Keller MB, Ryan ND, Strober M, Klein RG, Kutcher SP, Birmaher B, Hagina OR, Koplewicz H, Carlson GA, Clarke GN, Emslie GJ, Feinberg D, Geller B, Kusumakar V, Papatheodorou G, Sack WH, Sweeney M, Wagner KD, Weller EB, Winters NC, Oakes R, McCafferty JP (2001) Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 40:762–772

    Article  PubMed  CAS  Google Scholar 

  29. Kondro W, Sibbald B (2004) Drug company experts advised staff to withhold data about SSRI use in children. Can Med Assoc J 170:783

    Article  Google Scholar 

  30. Mann JJ, Emslie G, Baldessarini RJ, Beardslee W, Fawcett JA, Goodwin FK, Leon AC, Meltzer HY, Ryan ND, Shaffer D, Wagner KD (2006) ACNP Task Force report on SSRIs and suicidal behavior in youth. Neuropsychopharmacology 31:473–492

    Article  PubMed  CAS  Google Scholar 

  31. McCracken JT, McGough J, Shah B, Cronin P, Hong D, Aman M G, Arnold L E, Lindsay R, Nash P, Hollway J, McDougle CJ, Posey D, Swiezy N, Kohn A, Scahill L, Martin A, Koenig K, Volkmar F, Carroll D, Lancor A, Tierney E, Ghuman J, Gonzalez NM, Grados M, Vitiello B, Ritz L, Davies M, Robinson J, McMahon D, Research Units on Pediatric Psychopharmacology Autism Network (2002) Risperidone in children with autism and serious behavioural problems. N Engl J Med 347:314–321

    Article  PubMed  CAS  Google Scholar 

  32. Medawar C (1997) The antidepressant web—marketing depression and making medicines work. Int J Risk & Safety in Medicine 10:75–126

    Google Scholar 

  33. Ministero della Salute (2003) Nuove informazioni sulla sicurezza delle specialità medicinali contenenti paroxetina nel trattamento della malattia depressiva nei bambini e adolescenti al di sotto di 18 anni. Bollettino di Informazione sui Farmaci 5–6:207

    Google Scholar 

  34. Moynihan R, Cassels A (2005) Advertising disease. Premenstrual dysphoric disorder. In: Selling sickness. How the world’s biggest pharmaceutical companies are turning us all into patients. New York: Nation Books, pp 99–118

  35. Murray ML, Thompson M, Santosh PJ, Wong ICK (2005) Efficacy of the committee on safety of medicines advice on antidepressant prescribing to children and adolescents in the UK. Drug Safety 28:1151–1157

    Article  PubMed  CAS  Google Scholar 

  36. Murray ML, De Vries CS, Wong ICK (2004) A drug utilisation study of antidepressants in children and adolescents using the general practice research database. Arch Dis Child 89:1098–1102

    Article  PubMed  CAS  Google Scholar 

  37. National Institute for Health and Clinical Excellence (2005) Clinical guideline 28. Depression in children and young people: identification and management in primary, community and secondary care. National Institute for Health and Clinical Excellence, London

  38. Phillips CB (2006) Medicine goes to school: teachers as sickness brokers for ADHD. PLoS Med 3(4):e182

    Article  PubMed  Google Scholar 

  39. Poluzzi E, Motola D, Silvani C, De Ponti F, Vaccheri A, Montanaro M (2004) Prescriptions of antidepressants in primary care in Italy: pattern of use after admission of selective serotonin reuptake inhibitors for reimbursement. Eur J Clin Pharmacol 59:825–831

    Article  PubMed  Google Scholar 

  40. Quitkin FM, Petkova E, McGrath PJ, Taylor B, Beasley C, Stewart J, Amsterdam J, Fava M, Rosenbaum J, Reimherr F, Fawcett J, Chen Y, Klein D (2003) When should a trial of fluoxetine for major depression be declared failed? Am J Psychiatry 160:734–740

    Article  PubMed  Google Scholar 

  41. Raz A (2006) Perspectives on the efficacy of antidepressants for child and adolescent depression. PloS Med 3(1):e9

    Article  PubMed  Google Scholar 

  42. Safer DJ, Magno Zito J (2006) Treatment-emergent adverse events from selective serotinin reuptake inhibitors by age group: children versus adolescents. J Child Adolesc Psychopharmacol 16:159–169

    Article  PubMed  Google Scholar 

  43. Schirm E, Tobi H, de Jong-van den Berg LTW (2003) Risk factors for unlicensed and off-label drug use in children outside the hospital. Pediatrics 111:291–295

    Article  PubMed  Google Scholar 

  44. Schirm E, Tobi H, Magno Zito J, de-Jong-van den Berg LTW (2001) Psychotropic medication in children: a study from The Netherlands. Pediatrics 108: e25 Available at: http://www.pediatrics.org/cgi/content/full/108/2/e25. Accessed 5 May 2006

  45. Serreau R, Le Heuzey MF, Gilbert A, Mouren MC, Jacqz-Aigrain E (2004) Unlicensed and off-label use of psychotropic medications in French children: A prospective study. Paediatr Perinat Drug Ther 6:14–19

    Article  Google Scholar 

  46. Shea S, Turgay A, Carroll A, Schulz M, Orlik H, Smith I, Dunbar F (2004) Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics 114:e634–e641. Available at: http://www.pediatrics.org/cgi/doi/10.1542/peds.2003-0264-F. Accessed 5 May 2006

  47. Snyder R, Turgay A, Aman M, Binder C, Fisman S, Carroll A; The Risperidone Conduct Study Group (2002) Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. J Am Acad Child Adolesc Psichiatry 41:1026–1036

    Article  Google Scholar 

  48. Tischler B, Patriasz K, Beresford J, Bunting R (1972) Experience with pericyazine in profoundly and severe retarded children. Can Med Assoc J 106:103–141

    Google Scholar 

  49. Wagner KD, Jonas J, Findling RL, Ventura D, Saikali K (2006) A double-blind, randomized, placebo-controlled trial of escitalopram in the treatment of pediatric depression. J Am Acad Child Adolesc Psychiatry 45:280–288

    Article  PubMed  Google Scholar 

  50. Wagner KD, Robb AS, Findling RL, Jin J, Gutierrez MM, Heydorn WE (2004) A randomized, placebo-controlled trial of citalopram for the treatment of major depressi on in children and adolescents. Am J Psychiatry 161:1079–1083

    Article  PubMed  Google Scholar 

  51. Weintrob N, Cohen D, Klipper-Aurbach Y, Zadik Z, Dickerman Z (2002) Decreased growth during therapy with selective serotonin reuptake inhibitors. Arch Pediatr Adolesc Med 156:696–701

    PubMed  Google Scholar 

  52. Whittington CJ, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Boddington E (2004) Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 363:1341–1345

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Dr. Antonio Clavenna holds a fellowship granted by Boehringer Ingelheim Italia.

Author information

Authors and Affiliations

  1. Laboratory for Mother and Child Health, “Mario Negri” Institute for Pharmacological Research, Via Eritrea 62, 20157, Milan, Italy

    Antonio Clavenna

  2. CINECA Interuniversity Consortium, via Manganelli 6/3, 40033, Casalecchio di Reno, Bologna, Italy

    Elisa Rossi, Marisa DeRosa & Maurizio Bonati

Authors
  1. Antonio Clavenna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisa Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marisa DeRosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maurizio Bonati
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Clavenna.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Clavenna, A., Rossi, E., DeRosa, M. et al. Use of psychotropic medications in Italian children and adolescents. Eur J Pediatr 166, 339–347 (2007). https://doi.org/10.1007/s00431-006-0244-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-006-0244-7

Keywords

Search

Navigation