Little evidence for widespread prescribing of mood-altering drugs to children for mental health problems

There is limited evidence to support the widespread and increasing prescribing of mood-altering drugs (psychotropics) as the mainstay of mental health care for children and young people, experts warn in an editorial published today in the August issue of Bulletin on medicines and therapies.

But most importantly, current prescribing practices for these drugs, which include tranquilizers, anti-anxiolytics, antidepressants, antipsychotics and melatonin, need to be much safer, the researchers stress.

The number of these drugs prescribed to children and young people has been rising steadily, along with the tendency to prescribe them for longer periods, the editors note. They cite previously published British studies, which show that the prescribing rate of antipsychotics for children rose by more than 3% per year between 2000 and 2019, while the prescribing rate of antidepressants among 12-17 year-olds more than doubled between 2005 and 2017.

Another study found that more than 56,000 young people under the age of 17 used melatonin in 2022, a 168% increase from the corresponding figures in 2015.

The UK is not the only country increasingly relying on these drugs to treat children’s mental health problems, the editors point out. They cite data from a large US household survey showing a sharp rise in the number of young people prescribed a cocktail of these drugs, despite mounting concerns about the safety and effectiveness of such an approach.

The safety of psychotropic use in children has been poorly studied, the editors point out. But safety concerns about prescribing antipsychotics to children in foster care in particular have prompted the American Academy of Child and Adolescent Psychiatry to issue guidelines for clinicians advocating a “start low, go slow” approach.

These drugs should be reviewed regularly and stopped as soon as possible, the editors say. But the evidence suggests that primary care clinicians do not feel confident enough to taper the dose and frequency, while hospitalists feel that hospital stays are not long enough to start doing so.

“If psychotropic prescribing is to become a mainstay of managing mental health problems in children, and there is a limited evidence base to support such use, it must be safer,” the editors write. “There is a need for a better understanding of the level of risk that psychotropic agents pose, what doses are considered safe in different age groups, and at what point physical health monitoring should be required.”

They conclude: “Better shared supervision and shared decision-making, involving young people and their families in discussions about medication in both primary and secondary care, to ensure treatments are not continued when they are no longer needed, are vital.”