Antipsychotics (AP) are medications used to treat conditions such as schizophrenia or bipolar disorder. Although knowledge about the safety and effectiveness of AP use in children and adolescents is limited, AP is increasingly being used for other indications such as agitation, anxiety, and sleep disorders.
A new study at Ulm University Hospital (UKU) now shows that AP use among children and adolescents in Germany has increased significantly in recent years.
The study “Trends in antipsychotic use among children and adolescents in Germany: a study using 2011–2020 nationwide outpatient claims data” examined the prescription of antipsychotics among children and adolescents in Germany from 2011 to 2020 using nationwide billing data from outpatient care.
“We were able to show that antipsychotics were prescribed more and more frequently during this period,” explains Prof. Dr. Dr. Christian Bachmann, head of the health services research group at the UKU Clinic for Child and Adolescent Psychiatry/Psychotherapy and first author of the study. The use of typical antipsychotics, i.e. first-generation AP, rose from 1.16 per 1,000 to 1.35 per 1,000 children and adolescents, an increase of 16 percent. The use of atypical antipsychotics, i.e. more modern APs that cause fewer movement disorders compared to typical APs, increased from 2.35 to 2.75 per 1,000. This corresponds to an increase of 17 percent. The increase was particularly strong among girls.
“The marked increase in AP use among female adolescents aged 15 to 19 years, largely driven by increased use of the atypical antipsychotic quetiapine, is remarkable. Possible reasons for this increase – for example insufficient access to psychosocial therapies – should be carefully analyzed,” emphasizes Prof. Bachmann. Recent studies have shown that the risk of adverse metabolic changes and major cardiovascular events is increased even with low-dose quetiapine use.
Due to the significant increase in use and the lack of data for this vulnerable group, the researchers recommend further investigating the safety of quetiapine use in children and adolescents. In addition, the introduction of monitoring measures – e.g. more restrictive prescribing guidelines or training for prescribers – could be considered.
“Whether the increase in the use of antipsychotics in Germany is due to an increasing burden of mental disorders, to compensating for a lack of psychotherapeutic capacity or to other reasons must be examined in further research. What is clear, however, is that the safety of the use of antipsychotics in children and adolescents in particular needs to be further investigated,” sums up Prof. Bachmann.
The study was carried out in collaboration with the Leibniz Institute for Prevention Research and Epidemiology – BIPS in Bremen, the Central Institute for Statutory Health Insurance in Berlin and the Carl von Ossietzky University of Oldenburg and was published in the scientific journal “Frontiers in Psychiatry”.
(Press release: Ulm University Hospital)