A new international study found that children in the US were up to three times more likely to be given psychotropic drugs as kids in Germany and The Netherlands; and the researchers suggested this was because of differences in policies on drug advertising, drug classication, and cultural beliefs about using drugs to treat children’s emotional and behavioural problems.

The population-based study is published in the open access journal Child and Adolescent Psychiatry and Mental Health and was the work of lead researcher Dr Julie M Zito of the School of Pharmacy, University of Maryland, Baltimore, US, and colleagues from the US, Germany and The Netherlands.

There is much controversy over different country practices (and between the US and Western Europe in particular) in the use of antidepressants, like Prozac, and stimulants, like Ritalin, to treat children with behavioural and emotional problems.

For the study the researchers looked at administrative claims from major health insurance schemes made in 2000 in the United States, Germany and The the Netherlands, for use by nearly 6,000 children from 0 to 19 years of age. The key measure was the annual prevalence of psychotropic medication, which they defined as the “dispensing of 1 or more prescriptions for a psychotropic drug during the study year (2000) per 100 enrolled youth”.

Zito and colleagues found that:

  • The annual prevalence of any psychotropic medication for children aged 0 to 19 years was significantly greater in the US (6.7 per cent) than in the Netherlands (2.9 per cent) and in Germany (2.0 per cent).


  • Prevalence of antidepressants and stimulants was 3 or more times greater in the US than in The Netherlands and Germany.

  • Prevalence of antipsychotics was 1.5 to 2.2 times greater in the US than in The Netherlands and Germany.

  • Atypical antipsychotics represented only 5 per cent of antipsychotic use in Germany, but 48 per cent in The Netherlands and 66 per cent in the US.

  • Less commonly prescribed drugs such as alpha agonists, lithium and antiparkinsonian agents, were more prevalent among US kids followed by much rarer use (less than 0.05 per cent) among Dutch and German children.

  • Though rarely used, anxiolytics were twice as common in Dutch as in US and German kids.

  • Prescription hypnotics were half as common as anxiolytics in Dutch and US kids and very uncommon in German.

  • Using more than one drug at a time was far more common among the US kids (19.2 per cent prevalence); in fact it was more than double that of Dutch and three times that of German kids.

The authors concluded that:

“Prominent differences in psychotropic medication treatment patterns exist between youth in the US and Western Europe and within Western Europe.”

They suggested that:

“Differences in policies regarding direct to consumer drug advertising, government regulatory restrictions, reimbursement policies, as well as diagnostic classification systems, and cultural beliefs regarding the role of medication for emotional and behavioral treatment are likely to account for these differences.”

“A three-country comparison of psychotropic medication prevalence in youth.”
Zito JM, Safer DJ, de Jong-van den Berg LTW, Janhsen K, Fegert JM, Gardner JF, Glaeske G, Valluri SC.
Child and Adolescent Psychiatry and Mental Health 2008, 2:26 (25 September 2008).

Click here for Abstract.

Source: Journal article.

Written by: Catharine Paddock, PhD