Kids These Days… and Their Rx

Anticonvulsant use in children is increasing for mental health condition treatments

(RxWiki News) It's important to treat mental illness. But some people have concerns that children are over-treated with medications. Research evidence does show an increase in some psychiatric meds for kids.

A recent study found that kids are taking more and more anticonvulsant drugs, a specific class of medications. But they are not having more seizures, which anticonvulsants treat.

In other words, twice as many kids are getting prescribed anticonvulsants now than a little over a decade ago. Additionally, the increase appears to be driven by prescriptions for mental health conditions.

"Have your doctor explain the benefits of any Rx."

The study, led by Allen R. Tran, PharmD, from the University of Maryland School of Pharmacy's Pharmaceutical Health Services Research, aimed to find out the patterns in prescriptions of anticonvulsants for children.

Dr. Tran and his colleagues used data from two national health and hospital surveys that included outpatient information for children 17 and under.

They looked at the years 1996-97, 2000-01, 2004-05 and 2008-09 and focused on prescriptions for the six most common anticonvulsant drugs that are used for psychiatric disorders.

These drugs included divalproex (Depakote), lamotrigine (Lamictal), oxcarbazepine (Trileptal), carbamazepine (Carbatrol/Tegretol/Epitol/Equetro), topiramate (Topamax) and gabapentin (Gralise/Neurontin/Fanatrex/Gabarone/Horizant).

The researchers also used the medical records to identify whether the children getting these drugs were diagnosed with a seizure disorder or a psychiatric disorder. They found that over the time periods they looked at, the number of kids' visits that involved a psychiatric diagnosis increased 1.7 times even though visits related to seizures remained fairly steady.

The overall rate of anticonvulsant prescriptions meanwhile doubled. In the first year's data, 33 out of 10,000 children were being prescribed anticonvulsants. By 14 years later, 68 kids out of 10,000 were being prescribed them.

The two conditions linked the most to the increase in anticonvulsant use were pediatric bipolar disorder and disruptive behavior disorders.

The drug whose prescriptions increased the most for psychiatric conditions was lamotrigine while prescriptions for divalproex decreased for psychiatric conditions over the time period.

Anticonvulsants are often not approved by the US Food and Drug Administration to treat psychiatric illnesses, so their use for these conditions is considered "off-label" if the FDA has not indicated their use for a condition.

Off-label means that these drugs have not been required to be tested by the FDA for safety and effectiveness when used for the purpose of treating a condition.

"The growth of concomitant and off-label use to treat behavioral disorders raises questions about effectiveness and safety in community populations of youths," the authors wrote.

Glen Elliott, PhD, MD, a clinical professor at the Stanford University Department of Psychiatry and Behavioral Sciences and Chief Psychiatrist and Medical Director at Children's Health Council, said this study is an important contribution to the research describing how prescribing habits for children have changed over time.

"As the authors note, the increased use in young patients has occurred without much-needed data on safety and efficacy," Dr. Elliott told dailyRx News. "It well may reflect efforts to avoid antipsychotics, which are used to treat many of the same target symptoms. However, more data about the appropriateness of using the anticonvulsants in children with psychiatric disorders clearly is needed."

The study was published in the November issue of the journal Psychiatric Services. The research was funded by the Department of Pharmaceutical Health Services.

Review Date: 
November 8, 2012