More Americans taking drugs for mental illness

Many more Americans have been using prescription drugs to treat mental illness since 1996, in part because of expanded insurance coverage and greater familiarity with the drugs among primary care doctors, U.S. researchers said on Tuesday.

They said 73 percent more adults and 50 percent more children are using drugs to treat mental illness than in 1996.

Among adults over 65, use of so-called psychotropic drugs -- which include antidepressants, antipsychotics and Alzheimer's medicines -- doubled between 1996 and 2006.

"What we generally find is there has been an increase in access to care for all populations," said Sherry Glied of Columbia University in New York, whose study appears in the journal Health Affairs.

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Off-Label Prescribing

Medications cannot be marketed in the United States without an FDA determination that they are safe and effective for their intended use. To obtain such certification, pharmaceutical companies submit their products to rigorous scrutiny (eg, in vitro studies, animal studies, human clinical trials) and present the subsequent data to the FDA, which determines whether the medication in question is safe and effective for a specific purpose. FDA approval comes with specific labeling requirements for the product, including the approved indications for use, the appropriate dosing, and the specific populations for its use. Once a medication has been approved for a specific use, physicians and other prescribers are permitted to prescribe the medication for conditions not covered by the approved use.

Several recent studies have dem­onstrated that off-label prescribing is very common among physicians, particularly among psychiatrists. Legal scholars have estimated that approximately 40% to 60% of prescriptions are for off-label use.1 In one important study, researchers examined office-based prescribing patterns for 160 commonly prescribed medications and determined that approximately 21% were for off-label use. In this study, off-label use was most common for cardiac medications (46%), anticonvulsant medications (46%), and asthma medications (42%). The investigators also found that most off-label use (73%) had limited or no scientific support.

The greatest disparity in the percentage of scientifically supported versus unsupported off-label use occurred with psychiatric medications. In 96%, the off-label use was determined to have little or no sound scientific evidence for the condition for which the drug was prescribed.2

READ MORE @ PSYCHIATRIC TIMES

Prozac on the Playground - The dangers of off-label use of psychiatric medications in children.

Problem: We are now more aware of emotional illness in children and much more likely to diagnose and treat conditions like attention deficit disorders. But as difficult and expensive as it is to test new medications on adults, it's even harder to do the testing on children. Many treatments applied to children reflect "off-label" use of medications that have been specifically approved for adults—but not for kids. When the FDA grants a license to a new prescription medication, it lists its permitted uses ("indications") and the patients for whom it is intended (including their age range), usually reflecting the population it was tested on—children with strep throat, women with breast cancer. If a drug company even mentions a use not specifically approved, it has violated FDA rules and can be fined or otherwise punished. However, once a drug has received FDA approval, physicians are free to use it for applications or populations for which it was not formally approved. After (usually adult) FDA approval has been obtained, manufacturers often don't bother with expensive testing that would allow them to request a label extension for use in kids, since they'll have the (off-label) market, anyway. Off-label use accounts for somewhere between half and three-quarters of all medications used in children and is also commonly used for adult treatment. Pediatricians are often uncomfortable with this practice, but they consider it the lesser of two evils when confronting an illness with effective adult treatment but nothing for children. Most medications behave similarly in children and adults, but that rule has exceptions, as we sometimes discover too late. Aspirin can lead to a horribly dangerous liver and brain disease in children or teens. Tetracycline, a common antibiotic, can damage the teeth of children under 8 years old. The problem is particularly troublesome when it comes to prescribing psychiatric medications to kids, which is increasingly common.

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New focus on foster kids' meds

Psychiatric drugs - DHS prescribes more oversight and follow-up for youngsters under its care

Children in state foster care who are on psychiatric drugs would receive more oversight under a new plan to make sure they're on the right medications and getting the mental health help they need.

The draft proposal by the Oregon Department of Human Services could affect more than 2,000 foster children who receive psychiatric medications.

State officials last spring adopted new rules regarding psychiatric medications and foster children.

But The Oregonian reported in November that state law and rules governing the use of psychiatric medications in foster care are often ignored and that hundreds of children are taking multiple prescriptions with little or no state scrutiny.

READ MORE @ THE OREGONIAN