Antidepressant use by preschoolers rises dramatically

The use of antidepressants in children increased about 10% a year between 1998 and 2002, with a far greater increase among girls than boys, a new study says.

And although medication of preschool children remains limited to less than one half of 1%, the percentage of girls age 5 and younger on antidepressants doubled from 1998 to 2002, while use among preschool boys increased 64%. Still, only 0.16% of girls and 0.23% of boys in this age group were on antidepressants by 2002.

For children of all ages, antidepressant use increased 68% among girls and 34% for boys. Use was highest among girls age 15 to 18, at 6.8%.

The study appears in the current issue of the journal Psychiatric Services and was conducted by Express Scripts, a pharmacy benefit management company. Researchers analyzed antidepressant use among 2 million privately insured children.

Overall, antidepressant use among patients 18 and younger increased to 2.4% in 2002 from 1.6% in 1998, an almost 50% increase, they found.

The report showing continuing increased reliance on antidepressants for this population coincides with growing concern over the safety of certain antidepressants in children. Questions about the effectiveness of some of the drugs for children also have been raised.

“There are two differing viewpoints,” said Thomas Delate, director of research at Express Scripts and an author of the study. “One is the concern that antidepressants are being prescribed to youths without adequate information.”

On the other hand, he said, “Mental health advocates would say that we’re finally getting some recognition of the problem of depression in children.”

Last summer, Britain barred use of the selective serotonin reuptake inhibitor (SSRI) Paxil for depression in children because of an increase in self-harm and suicidal behavior.

The U.S. Food and Drug Administration later also recommended Paxil not be used to treat depression in children, saying trials showed it was no more effective than a placebo.

The study found the overall increase in antidepressant use in children was driven by an increase in the prescription of SSRIs -- the newest class of antidepressants.

Antidepressants are used to treat a wide range of disorders in children besides depression and are often used to treat attention deficit disorder, especially in boys.

Most of the uses are not specifically approved by the FDA, though doctors legally can use the drugs for nonapproved purposes.

Only Prozac is specifically approved for treating depression and obsessive-compulsive disorder in children. Zoloft and Luvox, two antidepressants, are approved for the treatment of obsessive-compulsive disorder in children.

“The use of Ritalin made it acceptable for parents to give children drugs,” said Dr. Lawrence Diller, a behavioral development pediatrician and author of “Should I Medicate My Child?” When Ritalin, a stimulant, fails to treat attention deficit disorder or hyperactivity, doctors sometimes add an antidepressant to the mix, and then a third drug if that doesn’t work, he said.

Thomas J. Moore, a health policy analyst at George Washington University, said his research showed an even greater increase in antidepressant use among children, possibly because his figures include a broad population, including children who don’t have private insurance.

“The drugs are used mostly for boys preadolescence, and mostly for girls during adolescence,” he said. “The drugs are being used for attention deficit disorder ... even though no drug has been shown effective. In the younger boys, the majority of the use is in that area.”

According to the FDA, more than 10 million children and teens younger than 18 took antidepressants in 2002.