Trends in the Use of Typical and Atypical Antipsychotics in Children and Adolescents NICK C. PATEL, PHARM.D., PH.D., M. LYNN CRISMON, PHARM.D., KIMBERLY HOAGWOOD, PH.D., MICHAEL T. JOHNSRUD, PH.D., KAREN L. RASCATI, PH.D., JAMES P. WILSON, PHARM.D., PH.D., AND PETER S. JENSEN, M.D. ABSTRACT Objective: To estimate prevalence rates of antipsychotic use in children and adolescents from 1996 to 2001 in three state Medicaid programs (midwestern [MM], southern [SM], and western [WM]) and one private managed care organization (MCO). Method: Prescription claims were used to evaluate antipsychotic prevalence, defined as the number of children and adolescents up to the age of 19 years with at least one prescription claim for an antipsychotic per 1,000 enrolled youths. Results: From 1996 to 2001, the prevalence of total antipsychotic use increased in each program (MM: 4.7 to 14.3 per 1,000; SM: 6.3 to 15.5; WM: 4.5 to 6.9; and MCO: 1.5 to 3.4). Typical antipsychotic use decreased (MM: 3.7 to 2.0 per 1,000; SM: 4.6 to 1.5; WM: 4.4 to 1.3; and MCO: 1.2 to 0.9), while atypical antipsychotic use dramatically increased (MM: 1.4 to 13.1 per 1,000; SM: 2.5 to 14.9; WM: 0.3 to 6.2; and MCO: 0.4 to 2.7). Conclusions: The increased prevalence of anti- psychotic use in children and adolescents from 1996 to 2001 was attributed to increased use of atypical antipsychotics. Given the limited data with atypical antipsychotics in youths, this emphasizes the need for additional studies of these agents and other treatment modalities in this population. J. Am. Acad. Child Adolesc. Psychiatry, 2005;44(6):548–556. Key Words: antipsychotics, pharmacoepidemiology. Antipsychotic use in children and adolescents increased from 1987 to 1996, ranging from a 1.6-fold to 5.5-fold increase (Zito et al., 2003). Examination of data from a midwestern Medicaid state demonstrated a trend of increased use of all antipsychotics starting in 1994 (Malone et al., 1999), attributable to the use of risper- idone, which was introduced in 1993. Although prev- alence estimates during the mid-1990s suggest a trend of increased atypical antipsychotic use among youths, these findings may not fully represent current prescrib- ing trends, as additional atypical antipsychotics were in- troduced in the late 1990s and early 2000s (olanzapine [1996], quetiapine [1997], and ziprasidone [2001]). Atypical antipsychotic use in youths was evaluated in Texas Medicaid from 1996 to 2000; the prevalence of total antipsychotic use increased from 7.7 to 20.0 chil- dren and adolescents per 1,000 enrollees (Patel et al., 2002). The change was due to a 494% increase in the prevalence of atypical antipsychotic use (2.7 [1996] to 16.0 [2000] per 1,000 enrolled youths). Although this raises questions about the growing use of antipsychotics, given the limited safety and efficacy data in children and adolescents, the generalizability of the results is limited because the sample population consisted only of youths enrolled in Texas Medicaid. It is unknown whether these prevalence rates are predic- tive of other state Medicaid programs, as studies have demonstrated geographic variation in antipsychotic pre- scribing (Hermann et al., 2002). It is also unknown Accepted January 4, 2005. Dr. Patel is with the Departments of Pharmacy Practice and Psychiatry, Uni- versity of Cincinnati; Drs. Crismon, Rascati, Wilson, and Johnsrud are with the Center for Pharmacoeconomic Studies, Divisions of Pharmacy Practice and Ad- ministration, The University of Texas at Austin; and Drs. Hoagwood and Jensen are with the Department of Psychiatry, Columbia University, New York. This study was supported by funding from National Institute of Mental Health, Eli Lilly and Company, and Texas Department of Mental Health and Mental Retardation. The authors thank Douglas Biber, Jeff McCombs, Terry West, Merle Habermann, Amy Solis, Edli Colberg, and Bertha Castro-Ugalde. Correspondence to Dr. Crismon, The University of Texas, 1 University Station, MC#A1910, Austin, TX 78712-0124; e-mail: crismonl@mail.utexas.edu. 0890-8567/05/4406–0548Ó2005 Journal of the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/01.chi.0000157543.74509.c8 548 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 44:6, JUNE 2005