Most teens with mental disorders are not taking psychiatric medications, according to a large study that counters a widespread perception.
Just 14% of U.S. teens with any mental disorder take medications designed to alter emotions or behavior, the study shows. In most cases, the medications are those considered appropriate for their conditions, says the report published online Monday in the Archives of Pediatrics & Adolescent Medicine. For example, those with attention deficit hyperactivity disorder (ADHD) are most likely to take stimulants, and teens with depression are most likely to take antidepressants.
The study is based on more than 10,000 interviews with teens 13 to 18 from 2001 to 2004. It contradicts "a lot of anecdotal reports that suggest kids are being overmedicated or mis-medicated," says lead author Kathleen Merikangas of the National Institute of Mental Health.
She says the study is the most representative on teens and mental disorders, but the data are several years old. It also doesn't include younger children. There is evidence that some subgroups are medicated at much higher rates, with unknown health consequences, some experts say.
"Medication use by the average population of typical kids in America could be low" partly because many families can't find or afford any mental health treatment, says David Rubin, a pediatrician at the Children's Hospital of Philadelphia.
But use among children on Medicaid appears much higher, he says. One study shows that 12% of foster children on Medicaid take anti-psychotic medications, powerful drugs that are a growing concern. Medicaid may make it easier for children with behavior problems to see doctors, but they often lack the time to do anything more than write prescriptions, Rubin says. He wrote an editorial accompanying the study.
Among the findings:
Medication use declined with age, especially for ADHD: 29% of kids 13-14 took stimulants such as Ritalin, but just 13% of those ages 17-18 did.
Just 25% of teens with any disorder got treatment from mental health specialists.
The study does not show whether the "right number" of teens got meds but suggests that "it's really challenging for families with mental health disorders to access appropriate treatment," says William Cooper, a professor of pediatrics at Vanderbilt University in Nashville. "I still have concerns about what appears to be a recent increase in use" of some medications, "including anti-psychotics, because we know so little about their effectiveness and side effects."
Some anti-psychotic medications can cause substantial weight gain and increase the risk of type 2 diabetes, Cooper says. Stimulants for ADHD can interfere with sleep and suppress appetite. Some antidepressants might increase risk of suicidal thinking and behavior in young people, but research suggests that benefits outweigh risks for teens with major depression, the institute says.
It's important for families to know about those advantages as well as the dangers, Merikangas says. "We certainly don't intend to say that all of these children should be on medication"; many will do best with behavior therapy and other interventions.
But, she says, "my concern has been parents and kids have become afraid of using medications." As a result, she says, some kids who need them probably are not getting them.
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