Prescription prevalence of psychotropic drugs in children and adolescents: an analysis of international data

Purpose: We conducted a review and meta-analysis to establish the international pooled prevalence of psychotropic drugs in children and adolescents, and comment on recent trends. Methods: Medline, Embase, and PsycINFO were searched for studies with annual prevalence estimates of attention deficit hyperactivity disorder (ADHD) medications, antidepressants, antipsychotics, sedative/hypnotics and anxiolytics in outpatient children and adolescents. Data were extracted regarding the representativeness, sampling frame, and the quality of reporting. Results: A total of 59 studies reporting prevalence data for 23 countries were collected. Most studies were conducted in Europe (42) and were at high or moderate risk of bias (35). The global random-effect pooled prevalence was 15.3‰ (95% confidence interval [CI], 7.6–25.7‰) for ADHD medications, 6.4‰ (95%CI 4.3–8.7) for antidepressants, and 5.5‰ (95%CI 3.6–7.8) for antipsychotics. Heterogeneity was extremely high (I2 > 99%). Large increases were found in the prevalence of ADHD medications in most countries, particularly up until 2010. The antidepressants’ trend was U-shaped in most countries with the lowest prevalence in 2007–2009 and rise more recently. Large to weak increases in the prevalence of antipsychotics were seen until 2011, and contrasting data were found more recently. Data on anxiolytics and sedative/hypnotics were limited. Conclusions: The study provides global estimates of paediatric psychotropic drug prevalence and its trends. Systematic monitoring is lacking in most countries, and very heterogeneous reporting is common across studies.