Dispensing of psychotropic medications to Australian children and adolescents doubled in less than a decade

A study from Monash University has found the prevalence of psychotropic dispensing for Australian children and adolescents aged 18 years and younger was twice as high in 2021 than in 2013.

The study was led by Dr Stephen Wood, Associate Professor Luke Grzeskowiak and Dr Jenni Ilomaki from the Centre for Medicine Use and Safety (CMUS) within the Monash Institute of Pharmaceutical Sciences.

Psychotropic drugs (e.g. antipsychotic, antidepressant, psychostimulant, anxiolytic, and sedative agents) can be prescribed for children and adolescents with mental disorders, including schizophrenia, attention deficit/hyperactivity disorder (ADHD), autism, depression and anxiety. 

The study, published in The Medical Journal of Australia and entitled Dispensing of psychotropic medications to Australian children and adolescents before and during the COVID-19 pandemic, 2013–2021: a retrospective cohort study found overall prevalence of psychotropic dispensing to children and adolescents was 3.4 per 100 boys and 2.5 per 100 girls in 2013, and 6.0 per 100 boys and 4.8 per 100 girls in 2021.

Dispensing during 2021 was highest for psychostimulants (generally used to treat ADHD) in boys, and antidepressants in girls. Overall, the increases in psychotropic dispensing were greatest among girls aged 13–18 years.

Senior author, Associate Professor Luke Grzeskowiak, said the reasons, and whether the marked increases in psychotropic dispensing during the COVID-19 pandemic was justified, particularly to adolescent girls, should be investigated.

“Although psychotropic drugs can benefit children and adolescents with mental disorders, their efficacy and safety in young people remains the subject of debate,” said Associate Professor Grzeskowiak.

“The increase in dispensing rates for several psychotropic classes was most notable during the COVID-19 pandemic, particularly for adolescent girls, and highlights the significant and potential long-lasting impacts the pandemic has had on the well-being of young people. Also, the fact that rates were in part driven by increased longer-term use of psychotropics is concerning, particularly given evidence of benefits and harms in young people is usually limited to short-term use.”

As dispensing prevalence was higher than predicted in 2021, the researchers compared dispensing changes in Victoria and New South Wales where COVID-19 lockdowns were more extensive than other states, and found that dispensing in Victoria and New South Wales were similar to other parts of Australia. This suggests that the impacts of the pandemic have been felt nationwide.

In addition, the prevalence of psychotropic polypharmacy for children and adolescents was also twice as high in 2021 than in 2013, with greater increases seen during the pandemic, particularly among girls aged 13-18. Polypharmacy is related to the use of two or more psychotropics and raises concerns about potential drug interactions and cumulative side effects.

“Dispensing rates for two or more psychotropic classes increased even more during the COVID-19 pandemic, particularly for adolescent girls,” said Dr Jenni Ilomaki from CMUS and a co-author on the study.

“This surge in rates of psychotropic polypharmacy raises concerns about potential drug interactions and cumulative side effects,” said Dr Ilomaki. 

The research was conducted in partnership with Flinders University and analysed data for people aged 18 years or younger in the Pharmaceutical Benefits Scheme (PBS) 10 percent sample dataset, a nationally representative, individual-level extract including all PBS dispensing data for a random 10 percent sample of Australians eligible for PBS-subsidised medicines. 

The overall body of research was funded by the Channel 7 Children’s Research Foundation. Associate Professor Grzeskowiak is the current Channel 7 Children’s Research Foundation Fellow in Medicines Use and Safety.