At a recent meeting of the state’s Psychopharmacology Trend Monitoring Group, of which I am a member, data was presented from the Department of Vermont Health Access that showed clear reductions over the last three years in the number of Vermont children taking psychiatric medications.
The data were compiled from children and adolescents who use Medicaid for their insurance. There were robust drops in most all classes of medications including ADHD medications, antidepressants, and antipsychotic medications. For example, the percentage of children not in foster care taking antipsychotic medications dropped 61%, 51%, and 47% in the 3-5, 6-10, and 13-17 year age groups from 2009 to 2011. Antipsychotic use for those in foster care dropped more modestly. Antidepressants and ADHD medications showed reductions generally around 20-40% in these age groups.
The one medication that clearly bucked the trend was the over the counter sleep aid melatonin which in some age groups showed increases of more than 100% from 2009.
What has led to the decrease isn’t clear. Those of us here at the Vermont Center for Children, Youth and Families would love to take some of the credit in our efforts to be conservative with psychiatric medications both in our own practice and in our recommendations to others (like during our conference Child Psychiatry in Primary Care), but it is likely that many factors are at play. Increased awareness by primary care physicians of the downsides of agents like antipsychotics may be leading to less comfort prescribing them on their own or without the fairly extensive lab tests that are recommended.
While I tend to take these data as generally good news, it is impossible to estimate from these data alone the extent to which the trends may also indicate that youth who should appropriately be getting pharmacotherapy are being denied access. In the end, the challenge for our state continues to be to ensure that children who should be using medications as a part of their treatment plan can get access to them while championing nonpharmacological options to the fullest extent possible.