Antipsychotics Prescribed to Boys More Often Than Girls

Young male patients tend to receive antipsychotic prescriptions more often than their female counterparts.

Since 2006, rates of antipsychotic use have increased among adolescents and young adults, yet decreased among children, according to a new study that examined antipsychotic prescription patterns and trends in pediatric patients.

The researchers examined patients aged 1 to 24 years and the number of antipsychotic prescriptions among them in 2006 (765,829), 2008 (858,216), and 2010, (851,874), plus a subset from 2009 with service claims (53,896). The prescription data came from the IMS LifeLink LRx Longitudinal Prescription database, which included 63% of all retail pharmacies in the nation, the authors said.

Age groups were broken down into several categories. Younger children were considered aged 1 to 6 years, older children were 7 to 12 years, adolescents were 13 to 18 years, and young adults were 19 to 24 years.

In 2010, 0.16% of younger male children were prescribed antipsychotics, whereas 0.06% of younger female children were prescribed the same treatment. For older children, the antipsychotic treatment rate was 1.20% for boys and 0.44% for girls. Among adolescents, boys’ rates were 1.42% compared with 0.95% for girls. For young adults, men’s rates dropped but were still above women’s (0.88% vs 0.81%).

Overall, the proportion of younger children prescribed antipsychotics decreased from 0.14% in 2006 to 0.11% in 2010, as did the rates for older children, which decreased from 0.85% to 0.80% in the same time period.

There was an increase in antipsychotic use among adolescents, however, from 1.10% in 2006 to 1.19% in 2010. Young adults’ usage also rose from 0.69% to 0.84% in that period.

Although antipsychotic prescription rates were higher in 2010 compared with 2006, the overall rate of antipsychotic prescriptions among young patients decreased from 2008 to 2010.

Importantly, the study suggested boys’ antipsychotic use is higher between ages 10 and 18, but then falls when they become young adults.

As patients grow older, the researchers posited, they could better suppress their aggression and improve their impulse control.

Another reason for this decrease is the potential impact of social factors. For instance, patients might refuse or discontinue their medications when they turn 18.

From the 2009 data, the researchers gleaned that younger children, older children, and adolescents who were prescribed antipsychotics and had claims for mental disorders were most often diagnosed

with attention-deficit/hyperactivity disorder (ADHD). Since the FDA has not approved any atypical antipsychotics to treat ADHD among children, this provides evidence of antipsychotic prescribing outside of FDA-approved indications, the researchers explained.

More than three-fourths of young patients on Medicaid are taking antipsychotics for an off-label purpose, according to a US Centers for Medicare & Medicaid Services (CMS) report.

“There are few clinical trials using atypical antipsychotics for off-label indications in pediatric patients,” the CMS report stated. “Additional research needs to be done to show safety and efficacy in this patient population.”

The current study was published in JAMA Psychiatry.