This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Prescriptions of antipsychotics to children and teenagers in England doubled between 2000 and 2019, research found. These drugs are treatments for mental health conditions such as bipolar disorder and schizophrenia. The study reported increases in both new and repeat prescriptions.
Prescriptions of antipsychotics for children and teenagers are increasing worldwide, despite a lack of safety data to support their use in the under 18s. This study assessed trends in antipsychotic prescribing for children and young people in primary care in England. Researchers analysed data on more than 7 million children from a national database.
Overall, very few children and young people received antipsychotics. But prescriptions doubled over 20 years due to an increase in new and repeat prescriptions. Children were prescribed antipsychotics for conditions for which there is no approval, such as autism. Those from deprived areas were more likely (than children in wealthier areas) to be prescribed older antipsychotics.
The findings suggest more young people are prescribed antipsychotics for longer periods and for more conditions. The researchers call for the use of antipsychotics in children and teenagers to be monitored. The safety of these drugs, especially over the long-term, needs to be assessed, they say.
For more information on antipsychotics, visit the NHS website.
The issue: how many children and teenagers are prescribed antipsychotics?
There is a lack of data on the safety of antipsychotics in young people because they are rarely trialled in people under 18. Most antipsychotics are not approved for use in children and young people. However, the prescription of antipsychotics in this group is increasing worldwide. There is concern that these medications could affect young people’s physical and mental development and, for instance, increase their risk of diabetes and conditions affecting the heart.
In the UK between 2011 and 2013, the National Institute for Health and Care Excellence (NICE) approved 3 antipsychotics for use in children and teenagers with specific conditions. Aripiprazole was approved for schizophrenia and bipolar disorder, clozapine for schizophrenia (when a young person has not benefitted from other treatment), and risperidone for children over 5 with severely aggressive conduct disorder (children find it difficult to behave and follow rules). Guidelines state that children and young people should be assessed by a psychiatrist before being prescribed these medications.
In this study, researchers reviewed trends in antipsychotic prescribing for children and young people in primary care in England.
What’s new?
Researchers examined patient records for children and young people (aged 3 to 18) in primary care between 2000 and 2019. More than 7 million children and teenagers were included in the analysis; half (48%) were girls.
Researchers determined the most likely reason children were prescribed antipsychotics (diagnosis) from records around the time of their first prescription.
They found that, between 2000 and 2019:
- 1 in 300 (0.3%) children and young people were prescribed antipsychotics at least once
- prescriptions of antipsychotics increased year on year (by 3%, on average) and roughly doubled over the period
- first prescriptions were most likely to be for autism (13%), psychosis (9%), and anxiety (8%).
Repeat prescriptions (issued within 18 months of the first prescription) made up 1 in 3 (35%) prescriptions in 2000; this increased to almost half (48%) in 2018. New prescriptions increased by 2% per year on average. The most prescribed antipsychotics were risperidone, aripiprazole, and quetiapine.
Overall prescription rates were similar in most and least deprived areas. However, children and teenagers in deprived areas were more likely to be prescribed older, cheaper, first-generation antipsychotics. Twice as many boys received antipsychotics as girls, almost every year.
Why is this important?
Between 2000 and 2019, prescriptions of antipsychotics doubled among children and adolescents in primary care in England. This was due to increases both in repeat and new prescriptions. The findings suggest that more young people are being prescribed antipsychotics for longer periods and for more conditions. However, overall, prescriptions of antipsychotics to children and young people remain low.
Some areas of concern were highlighted. Children were prescribed antipsychotics for conditions such as autism, for which antipsychotics have not been approved in the UK. Those from deprived areas were more likely to be prescribed first-generation antipsychotics, which are older, cheaper, less commonly prescribed, and more likely to cause some side effects (such as sudden twitches and uncontrollable movements caused by tardive dyskinesia).
Prescriptions in secondary care (where most antipsychotics are first prescribed) were not captured in the study, so the overall numbers of prescriptions may be higher than was shown. Researchers assigned the most likely reason for the prescription from the data available; but this may not always have been correct.
What’s next?
The findings highlight the need for continued monitoring of trends in antipsychotic use, and for further research into the short- and long-term safety of antipsychotics in children and young people. A national audit of existing prescribing practices in primary and secondary care could help ensure that clinicians are following current recommendations, the researchers say, and identify gaps between guidance and practice that may be harming young people.
Further research could explore why clinicians are prescribing antipsychotics for a wider range of conditions; and the reasons why older antipsychotics are prescribed in deprived areas.
You may be interested to read
This Alert is based on: Radojčić MR, and others. Trends in antipsychotic prescribing to children and adolescents in England: cohort study using 2000–19 primary care data. Lancet Psychiatry 2023; 10: 119–128.
An article about the study in The Conversation.
An Alert on the increased use of antidepressants by teenagers.
Information on the NHS website about a campaign to reduce the use of medications in children with learning disabilities and autism.
Funding: The study was funded by NIHR Applied Research Collaboration Greater Manchester.
Conflicts of Interest: None declared.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
