Ambulatory Use of Psychotropics by Employer-Insured Children and Adolescents in a National Managed Care Organization

Objective.—To provide a description of the ambulatory use of psychotropic medications by children and adolescents in a large, geographically diverse employer-insured population.

Design.—This retrospective observational study used administrative claims data for 1995–1999 for members under age 20 in 6 Independent Practice Association health plans affiliated with UnitedHealth Group. We calculated the prevalences of use for 4 major therapeutic drug classes: central nervous system stimulants (CNSSs), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and other antidepressants (OADs). Changes over time by age, gender, geographic region, and prescriber specialty were analyzed across drug classes.

Results.—The prevalence of CNSS, SSRI, and OAD use steadily increased over the 5-year period, whereas TCA use decreased. The prevalence of use of the most commonly used classes, the CNSS and SSRI classes, increased from 23.8 to 30.0 per 1000 and 7.9 to 12.8, respectively. There was variability across and within geographic regions. Pediatricians were the most frequent first prescribers of CNSS, and psychiatrists were most likely to prescribe SSRIs.

Conclusion.—Acceleration of use of psychotropic medications is slower in an employer-insured national population. Since primary care physicians are frequent prescribers of psychotropics, their training and expertise are crucial.

KEY WORDS:  attention deficit-hyperactivity disorder , depression , employer-insured , psychotropics