Psychoactive medication prescribing practices for US children: Gaps between research and clinical practice

Objective: To determine national pediatric prescribing practices for psycho tropic agents and to examine these practices in view of the available evide nce concerning their safety and efficacy in this age group. Method: Prescri bing data from 2 national databases based on surveys of office-based medica l practices were determined and reviewed vis-g-vis available safety and eff icacy evidence. Results: Data indicate that levels of psychotropic prescrib ing in children and adolescents are greatest for stimulants, resulting in n early 2 million office visits and 6 million drug "mentions" in 1995. Select ive serotonin reuptake inhibitors were the second most prescribed psychotro pic agents, while anticonvulsant mood stabilizers (prescribed for a psychia tric reason), tricyclic antidepressants, central adrenergic agonists, antip sychotics, benzodiazepines, and lithium were also prescribed for a substant ial number of office visits. Comparison of prescribing frequencies with ava ilable safety and efficacy data indicates significant gaps in knowledge for commonly used agents. Conclusions: Most psychotropic agents require furthe r sustained study to ensure appropriate health care expenditures and vouchs afe children's safety. Recommendations for researchers, parents, federal ag encies, and industry are offered as a means to accelerate the pace of resea rch progress.