ORIGINAL RESEARCH

 

Prescribing patterns of medicine classified as 'antidepressants' in South African children and adolescents

 

 

Johanita R. Burger; Elmarie van der Westhuizen; Martie S. Lubbe; Jan H.P. Serfontein

School of Pharmacy, North-West University (Potchefstroom Campus), South Africa

Correspondence

 

 

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ABSTRACT

The main objective of this study was to characterise prescribing patterns of medicine classified as 'antidepressants' (hereafter simply referred to as antidepressants) in children and adolescents in the private health care sector of South Africa. A retrospective drug utilisation design was used to identify patients aged 19 years and younger from a South African pharmaceutical benefit management company's database, whom were issued at least one antidepressant between 1 January 2006 and 31 December 2006. Prescribed daily dosages (PDDs) were calculated using the Statistical Analysis System® program. A total of 1 013 patients received a mean number of 2.88 (SD 3.04) prescriptions per patient. Females received more prescriptions than their male counterparts, with the highest prevalence in the 15≤19 years age group. The pharmacological groups most prescribed were the selective serotonin reuptake inhibitors (43.0%) and the tricyclics (42.7%), with imipramine (22.04%) and amitriptyline (19%) as the most commonly prescribed drugs. Approximately 30% (n = 2 300) of all antidepressants in the study population were prescribed off-label. Amitriptyline and clomipramine were prescribed at daily dosages higher than recommended in children and adolescents aged 9 ≤ 15 years. Lithium, trimipramine, trazodone and sulpiride were prescribed at sub-therapeutic dosages in adolescents. This study provided insight in the prescribing patterns of medicine classified as antidepressants in South African children and adolescents. These drugs, however, have many indications. Further research is needed to determine reasons why specific drugs are prescribed in this population.

Keywords: antidepressants; South African private health care sector; retrospective drug utilisation; prescribing patterns; prescribed daily dosages

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OPSOMMING

Die algemene doelstelling van hierdie studie was om die voorskrifpatrone van middels wat as 'antidepressante' geklassifiseer word (hierna verwys na as slegs antidepressante) wat vir kinders en adolessente in die Suid-Afrikaanse private gesondheidsorgsektor voorgeskryf word, te beskryf. 'n Retrospektiewe medisyneverbruiksontwerp is gebruik om pasiënte 19 jaar en jonger, wat in die periode van 1 Januarie 2006 tot 31 Desember 2006 ten minste een voorskrif vir 'n antidepressant ontvang het, in die databasis van 'n Suid-Afrikaanse farmaseutiese voordelebestuursmaatskappy te identifiseer. Voorgeskrewe daaglikse dosisse (VDDs) is bereken deur van die program Statistical Analysis System® gebruik te maak. 'n Totaal van 1 013 pasiënte het 'n gemiddeld van 2.88 (SA 3.04) voorskrifte per pasiënt ontvang. Vroue het meer voorskrifte as hul manlike eweknieë ontvang, met die hoogste voorkoms in die ouderdomsgroep 15 ≤ 19 jaar. Die farmakologiese groepe selektiewe serotonienheropnameremmers (43.0%) en die trisikliese antidepressante (42.7%) is die meeste voorgeskryf, met imipramien (22.04%) en amitriptilien (19%) as die mees algemeen voorgeskrewe middels. Ongeveer 30% (n = 2 300) van alle antidepressante in die studiepopulasie is voorgeskryf vir indikasies waarvoor dit nie geregistreer is nie. Amitriptilien en klomipramien is teen daaglikse dosisse hoër as die aanbevole vir 9≤15-jarige kinders en adolessente voorgeskryf. Litium, trimipramien, trasodoon en sulpiried is teen sub-terapeutiese dosisse vir adolessente voorgeskryf. Hierdie studie het insig verleen ten opsigte van die voorskrifpatrone van middels wat as antidepressante geklassifiseer word vir Suid-Afrikaanse kinders en adolessente. Hierdie middels het egter baie gebruike. Verdere navorsing word benodig om redes te bepaal waarom sekere middels in hierdie populasie voorgeskryf word.

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References

Ables, A.Z. & Baughman, O.L., 2003, 'Antidepressants: Update on new agents and indications', American Family Physician 67(3), 547-554.         [ Links ]

APA Working Group on Psychoactive Medications for Children and Adolescents, 2006, Psychopharmacological, psychosocial, and combined interventions for childhood disorders: Evidence base, contextual factors, and future directions, American Psychological Association Washington DC.         [ Links ]

Arnold, L.E., 1996, Sex differences in ADHD: Conference summary. Journal of Abnormal Child Psychology 24, 555-569.         [ Links ]

Banaschewski, T., Roessner, V., Dittmann, R.W., Santosh, P.J. & Rothenberger, A., 2004, 'Non-stimulant medications in the treatment of ADHD', European Child and Adolescent Psychiatry 13(S1), i102-i116.         [ Links ]

Boseley, S., 2003, 50,000 children taking antidepressants, viewed 1 September 2008, from http://www.guardian.co.uk/uk_news/story/0,3604,1045902,00.html.         [ Links ]

Bridge, J.A., Iyengar, S., Salary, C.B., Barbe, R.P., Birmaher, B., Pincus, H.A. et al., 2007, 'Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials', The Journal of the American Medical Association 297(15), 1683-1696.         [ Links ]

British National Formulary for Children, 2008, Antidepressant drugs, viewed 1 September 2008, from http://www.medicinescomplete.com/mc/bnfc/current/.         [ Links ]

Canadian Paediatric Society, 2005, 'Management of primary nocturnal enuresis', Paediatrics & Child Health 10(10), 611-614.         [ Links ]

Centers for Disease Control and Prevention, 2000, 2000, CDC Growth Charts: United States, viewed 1 September 2008, from http://www.cdc.gov/growthcharts.         [ Links ]

Cotgrove, A., 2007, 'Should young people be given antidepressants? Yes', British Medical Journal 335(7623), 750.         [ Links ]

Daly, J.M. & Wilens, T., 1998, 'The use of tricyclic antidepressants in children and adolescents', Pediatric Clinics of North America 45(5), 1123-1135.         [ Links ]

Debar, L.L., Lynch, F., Powell, J. & Gale, J., 2003, 'Use of psychotropic agents in preschool children: Associated symptoms, diagnoses, and health care services in a health maintenance organization', Archives of Pediatrics and Adolescent Medicine 157(2), 150-157.         [ Links ]

Deubner, D.C., 1977, 'An epidemiological study of migraine and headache in 10-20 year olds', Headache 17, 173-80.         [ Links ]

Everett, A.V., 2002, 'Pharmacologic treatment of adolescent depression', Current Opinion in Pediatrics 14(2), 213-218.         [ Links ]

Friedman, R.A. & Leon, A.C., 2007, 'Expanding the black box - depression, antidepressants, and the risk of suicide', The New England Journal of Medicine 356(23), 2343-2346.         [ Links ]

Gaub, M. & Carlson, C.L., 1997, 'Gender differences in ADHD: A meta-analysis and critical review', Journal of the American Academy of Child & Adolescent Psychiatry 36, 1036-1045.         [ Links ]

Gelder, M., Mayou, R. & Geddes, J., 1999, Psychiatry, Oxford University Press, New York.         [ Links ]

Geller, D.A., Biederman, J., Stewart, S.E., Mullin, B., Martin, A., Spencer, T. et al., 2003, 'Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder', The American Journal of Psychiatry 160(12), 1919-1928.         [ Links ]

Gibbon, C.J., 2003, South African Medicines Formulary, South African Medical Association, Pinelands.         [ Links ]

Gowers, S.G., 2008, 'Management of eating disorders in children and adolescents', Archives of Disease in Childhood 93, 331-334.         [ Links ]

Hazell, P., O'Connell, D., Heathcote, D. & Henry, D., 2002, 'Tricyclic drugs for depression in children and adolescents', Cochrane Database of Systematic Reviews 2, CD002317        [ Links ]

Insurance Za., 2008, Medical Schemes South Africa, viewed September 2009, from available at: http://www.medicalscheme.co.za.         [ Links ]

ISERM, 2002, Mental disorders: Screening and prevention on children and adolescents, Institute National de la Santé et de la Recherché Médicale, Paris.         [ Links ]

Jacob, E., 2004, 'Neuropathic pain in children with cancer',, Journal of Pediatric Oncology Nursing 21(6), 350-357        [ Links ]

Johnston, M. & Mcnaughton, M., 2007, Antidepressants given to babies, viewed 1 September 2008, from http://www.nzherald.co.nz/section/1/print.cfm?c_id=1&obj ectid=10462684&pnum=0.         [ Links ]

Kairuz, T., Truter, I., Hugo, J. & Foxcroft, C., 2003, 'Prescribing patterns of tricyclic and selective reuptake inhibitor antidepressants among a sample of adolescents and young adults', Pharmacoepidemiology and Drug Safety 12(5), 379-382.         [ Links ]

Kastelic, E.A., Labellarte, M.J. & Riddle, M.A., 2000, 'Selective serotonin reuptake inhibitors for children and adolescents', Current Psychiatry Reports 2, 117-123.         [ Links ]

Ladikos, A., 2003, 'Depression in childhood and adolescence', Serenity: Anxiety and Depression - A Positive Outlook 1(1), 4-5.         [ Links ]

Lewis, D.W., 2002, 'Headaches in children and adolescents', American Family Physician 65, 625-632; 635-636.         [ Links ]

Ma, J., Lee, K.V. & Stafford, R.S., 2005, 'Depression treatment during outpatient visits by U.S. children and adolescents', Journal of Adolescent Health 37, 434-442.         [ Links ]

Malahyde Information Systems, 2008, South African electronic package inserts, viewed 1 September 2008, from http://www.home.intekom.com/pharm/.         [ Links ]

Martin, A., Van Hoof, T., Stubbe, D., Sherwin, T. & Scahill, L., 2003, 'Multiple psychotropic pharmacotherapy among child and adolescent enrollees in Connecticut Medicaid managed care', Psychiatric Services 54(1), 72-77.         [ Links ]

Murray, M.L., De Vries, C.S. & Wong, I.C.K., 2004, 'A drug utilisation study of antidepressants in children and adolescents using the General Practice Research Database', Archives of Disease in Childhood 89, 1098-1102.         [ Links ]

Murray, M.L., Wong, I.C.K. & De Vries, C.S., 2004, 'Treating major depression in children and adolescents: Research is needed into safer and more effective drugs', British Medical Journal 328(7438), 524-525.         [ Links ]

Olfson, M., Marcus, S.C., Weissman, M.M. & Jensen, P.S., 2002, 'National trends in the use of psychotropic medications by children', Journal of the American Academy of Child & Adolescent Psychiatry 41(5), 514-521.         [ Links ]

Owens, J.A., 2006, 'Pediatric insomnia', Sleep Medicine Clinics 1(3), 423-435.         [ Links ]

Pelayo, R. & Dubik, M., 2008, 'Pediatric sleep pharmacology', Seminars in Pediatric Neurology 15, 79-90.         [ Links ]

Perry, P.J., Alexander, B., Liskow, B.I. & Devane, L.C., 2006, Psychotropic drug handbook, Lippincott Williams & Wilkins, Philadelphia.         [ Links ]

Pliszka, S.R., 1991, 'Antidepressants in the treatment of child and adolescent psychopathology', Journal of Clinical Child Psychology 20(3), 313-321.         [ Links ]

Rosack, J., 2003, 'FDA warns of suicide risk with paroxetine', Psychiatric News 38(14), 1-37.         [ Links ]

Rosack, J., 2006, 'Off-label psychotropic use reveals complex patterns', Psychiatric News 41(14), 16.         [ Links ]

SAS FOR WINDOWS 9.1. 2005. SAS Institute Inc., 2002-2003.         [ Links ]

Scahill, L., Leckman, J.F., Schultz, R.T., Katsovich, L. & Peterson, B.S., 2003, 'A placebo-controlled trial of risperidone in Tourette syndrome', Neurology 60, 1130-1135.         [ Links ]

Scribante, L., 2005, Antidepressants in children and adolescents scientifically considered, viewed 1 September 2009, from http://www.sasop.co.za/D_patientdeu_T_F_020.asp.         [ Links ]

Silber, T.J. & Valadez-Meltzer, A., 2005, 'Premenstrual dysphoric disorder in adolescents: Case reports of treatment with fluoxetine and review of the literature', Journal of Adolescent Health 37, 518-525.         [ Links ]

Smellie, J.M., McGrigor, V.S., Meadow, S.R., Rose, S.J. & Douglas, M.F., 1996, 'Nocturnal enuresis: A placebo controlled trial of two antidepressant drugs', Archives of Disease in Childhood 75(1), 62-66.         [ Links ]

Snyman, J.R., 2006, MIMS Monthly Index of Medical Specialities, Ultro-Litho, Pretoria.         [ Links ]

Sung, S.E. & Kirchner, J.T., 2000, 'Depression in children and adolescents', American Family Physician 62(10), 2297-2312.         [ Links ]

Sweetman, S., 2008, Martindale: The Complete Drug Reference, viewed 1 September 2008, from http://www.medicinescomplete.com/mc/martindale/current/.         [ Links ]

Tagliente, F., Ruju, F.M. & Pascotto, A., 2004, 'Treatment of episodic and chronic tension-type headache in children and adolescents', The Journal of Headache and Pain 5(S2), 1129-2369.         [ Links ]

The Clomipramine Collaborative Study Group, 1991, 'Clomipramine in the treatment of patients with obsessive-compulsive disorder', Archives of General Psychiatry 48, 730-738.         [ Links ]

United States Food and Drug Administration, 2003, FDA Issues public health advisory entitled: Reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder (MDD), viewed 2 September 2008, from http://www.fda/bbs/topics/ANSWERS/2003/ANS01256.html.         [ Links ]

United States Food and Drug Administration, 2005, Antidepressant use in children, adolescents, and adults, viewed 1 September 2008, from http://www.fda.gov/cder/drug/antidepressants/default.htm.         [ Links ]

Wilens, T.E., Biederman, J., Baldessarini, R.J., Geller, B., Schleifer, D., Spencer, T.J., Birmaher, B. et al., 1996, 'Cardiovascular effects of therapeutic doses of tricyclic antidepressants in children and adolescents', Journal of the American Academy of Child & Adolescent Psychiatry 35(11), 1491-1501.         [ Links ]

Woodruff, T.J., Axelrad, D.A., Kyle, A.D., Nweke, O., Miller, G.G. & Hurley, B.J., 2004, 'Trends in environmentally related childhood illnesses', Pediatrics 113, 1133-1140.         [ Links ]

World Health Organization, 2004, 'Selective serotonin reuptake inhibitors (SSRIs): Use in children with major depressive disorder', WHO Pharmaceuticals Newsletter 3, 8-10.         [ Links ]

Wyeth, 2003, Effexor® (venlafaxine hydrochloride) tablets, Wyeth Pharmaceuticals, Philadelphia.         [ Links ]

Zito, J.M., Safer, D.J., Dosreis, S., Gardner, J.F., Boles, J. & Lynch, F., 2000, 'Trends in prescribing of psychotropic medication in preschoolers', Journal of the American Medical Association 283(8), 1025-1030.         [ Links ]

Zullino, D.F., Schwartz, B., Bilancioni, R. & Baumann, P., 2008, 'Off-label utilization of antidepressants', Acta Medica 51(1), 19-24.         [ Links ]

 

 

Correspondence:
Johanita R. Burger
Medicine Usage in South Africa (MUSA)
School of Pharmacy
North-West University (Potchefstroom Campus)
South Africa
E-mail: johanita.burger@nwu.ac.za

Received: 27 Oct. 2008
Accepted: 25 Feb. 2009
Published: 16 July 2009