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Paediatric psychotropic dispensing doubles in less than 10 years

New research shows use of the medications has soared since 2013, but there ‘may be more to it than first meets the eye’.

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

The research, published in The Medical Journal of Australia, revealed that the overall prevalence of psychotropic dispensing to children and adolescents was six per 100 boys and 4.8 per 100 girls in 2021, compared to 3.4 per 100 boys and 2.5 per 100 girls in 2013.

It also showed that dispensing during 2021 was highest for psychostimulants 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 determining 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,’ he said.

‘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.’

Dr James Best, Chair of RACGP Specific Interests Child and Young Person’s Health, agrees that more investigation is required, but told newsGP ‘there may be more to it than first meets the eye’.

‘It’s almost an instinctive reaction to say, “oh, that’s bad”, but it might not necessarily be bad because there are a lot of moving parts in this in this picture,’ he said.

‘This is not a straightforward situation as to whether this is a good or bad thing … because it may be that prescribing has increased because there’s improving awareness and access for when medication may be appropriate.’

One of the main drivers for the increased dispensing, Dr Best suggests, could be greater awareness of ADHD and more people wanting to trial medication.

‘That [condition] has historically been very underdiagnosed,’ he said.

However, he also says the level of concern ‘really depends on the medication’ as there are a lot of variables involved.

‘[For example], there has been a suggestion of a slight increase in suicidal ideation in the use of SSRIs in adolescents and the safety data and the amount of data we have in general on the use of SSRIs in children and young people is not great,’ he said.

‘So they are medications that need to be used with caution.’

As part of the research, dispensing prevalence was compared between states that underwent more extensive restrictions in 2021 – such as Victoria and New South Wales – compared to other parts of the country, but no major differences were identified, suggesting that the impacts of the pandemic were felt nationwide.

The prevalence of psychotropic polypharmacy was also tracked and found to be twice as high in 2021 than in 2013.

‘Dispensing rates for two or more psychotropic classes increased even more during the COVID-19 pandemic, particularly for adolescent girls,’ co-author Dr Jenni Ilomaki said.

‘This surge in rates of psychotropic polypharmacy raises concerns about potential drug interactions and cumulative side effects.’

The research analysed data for people aged 18 years or younger in the PBS sample dataset, a nationally representative, individual-level extract including all PBS dispensing data for a random 10% sample of Australians eligible for PBS-subsidised medicines. 

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