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. 2016 Dec;61(12):758-765.
doi: 10.1177/0706743716649190. Epub 2016 Jul 10.

Interprovincial Variation in Antipsychotic and Antidepressant Prescriptions Dispensed in the Canadian Pediatric Population

Nikita Arora  1 , Sandra Knowles  2   3 , Tara Gomes  2   3   4   5 , Muhammad M Mamdani  2   3   4   5 , David N Juurlink  4   5   6 , Corine Carlisle  7   8 , Mina Tadrous  2   3   4
Affiliations

Interprovincial Variation in Antipsychotic and Antidepressant Prescriptions Dispensed in the Canadian Pediatric Population

Nikita Arora et al. Can J Psychiatry. 2016 Dec.

Abstract
in English, French

Objective: Although antidepressants and antipsychotics are valuable medications in the treatment of select psychiatric disorders, there is increasing focus on the balance of risks and benefits of these drugs as prescribed, particularly in the pediatric population. We examined recent national trends and interprovincial variation in dispensing of antipsychotic and antidepressant prescriptions to the Canadian pediatric population.

Method: We conducted a population-based cross-sectional study of antidepressant and antipsychotic prescriptions dispensed by Canadian pharmacies to the pediatric population (≤18 years) between 2010 and 2013. Prescription volumes were obtained from IMS Health. Analysis was stratified by drug, year, quarter, and province and population-standardized using age-adjusted population estimates.

Results: From the first quarter of 2010 to the fourth quarter of 2013, dispensing of antipsychotics to the pediatric population increased 33% (from 34 to 45 prescriptions per 1000) and dispensing of antidepressants increased 63% (from 34 to 55 per 1000). We observed a 1.5-fold interprovincial difference in dispensing rates for antidepressants (range: 189 per 1000 to 275 per 1000) and a 3.0-fold difference for antipsychotics (range: 85 per 1000 to 253 per 1000) in 2013. Among antidepressants, selective serotonin reuptake inhibitors were the most dispensed (76%), with fluoxetine being the leading agent. Among antipsychotics, atypical antipsychotics were the most dispensed (97%), with risperidone being the leading agent.

Conclusions: Antipsychotic and antidepressant dispensing to the Canadian pediatric population increased from 2010 to 2013, with considerable interprovincial variation. Future research is required to explore reasons for observed patterns to optimize care for the Canadian pediatric population.

Objectif:: Bien que les antidépresseurs et les antipsychotiques soient des médicaments valables pour le traitement de troubles psychiatriques désignés, on s’interroge de plus en plus sur l’équilibre des risques et des avantages de ces médicaments tels que prescrits, particulièrement dans la population pédiatrique. Nous avons examiné les récentes tendances nationales et la variation interprovinciale de la dispensation des prescriptions d’antipsychotiques et d’antidépresseurs dans la population pédiatrique canadienne.

Méthode:: Nous avons mené une étude transversale dans la population des prescriptions d’antidépresseurs et d’antipsychotiques dispensées par les pharmacies canadiennes à la population pédiatrique (≤ 18 ans) entre 2010 et 2013. Les volumes des prescriptions ont été obtenus d’IMS Health. L’analyse a été stratifiée selon le médicament, l’année, le trimestre, et la province, et selon la population normalisée à l’aide des estimations de population ajustées selon l’âge.

Résultats:: Du premier trimestre de 2010 au quatrième trimestre de 2013, la dispensation d’antipsychotiques à la population pédiatrique a augmenté de 33% (de 34 à 45 prescriptions par 1 000) et la dispensation d’antidépresseurs a augmenté de 63% (de 34 à 55 par 1 000). Nous avons observé une différence interprovinciale de 1,5 fois des taux de dispensation d’antidépresseurs (étendue: 189 par 1 000 à 275 par 1 000) et une différence de 3 fois pour les antipsychotiques (étendue: 85 par 1 000 à 253 par 1 000) en 2013. Parmi les antidépresseurs, les inhibiteurs spécifiques du recaptage de la sérotonine étaient les plus dispensés (76%), la fluoxétine étant le principal agent. Pour les antipsychotiques, les antipsychotiques atypiques étaient les plus dispensés (97%), et la rispéridone était le principal agent.

Conclusions:: La dispensation d’antipsychotiques et d’antidépresseurs à la population pédiatrique canadienne a augmenté de 2010 à 2013, et elle présente une variation interprovinciale considérable. Il faut plus de recherche pour explorer les raisons des modèles observés afin d’optimiser les soins pour la population pédiatrique canadienne.

Keywords: antidepressive agents; antipsychotic agents; mental health; pediatrics; psychotropic drugs.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Mamdani reports receiving honoraria for serving on Advisory Boards for Astra Zeneca, Bristol-Myers Squibb, Eli Lilly and Company, Glaxo Smith Kline, Hoffman La Roche, Novartis, Novo Nordisk, and Pfizer, outside the submitted work. The remaining authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
National antipsychotic and antidepressant dispensing rates from 2010 to 2013.
Figure 2.
Figure 2.
Antipsychotic and antidepressant dispensing rates in 2013, by province.
Figure 3.
Figure 3.
Antidepressant dispensing rates in 2013, by agent and province.
Figure 4.
Figure 4.
Selective serotonin reuptake inhibitor dispensing rates in 2013, by agent and province.
Figure 5.
Figure 5.
Antipsychotic dispensing rates in 2013, by agent and province.
See this image and copyright information in PMC

References

    1. Alessi-Severini S, Biscontri RG, Collins DM, et al. Ten years of antipsychotic prescribing to children: a Canadian population-based study. Can J Psychiatry. 2012;57(1):52–58. - PubMed
    1. Zito JM, Safer DJ, DosReis S, et al. Psychotropic practice patterns for youth: a 10-year perspective. Arch Pediatr Adolesc Med. 2003;157(1):17–25. - PubMed
    1. Merikangas KR, He J, Rapoport J, et al. Medication use in US youth with mental disorders. JAMA Pediatr. 2013;167(2):141–148. - PubMed
    1. Doran C. Prescribing mental health medication: the practitioner’s guide. 2nd ed New York: Routledge; 2013.
    1. Lam D, Gorman D, Patten S, et al. The pharmacoepidemiology of selective serotonin reuptake inhibitors for children and adolescents in Canada from 2005 to 2009: a database analysis. Paediatr Drugs. 2013;15(4):319–327. - PubMed

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