van den Ban Els, Souverein Patrick, Swaab Hanna, van Engeland Herman, Heerdink Rob, Egberts Toine
Department of Child and Adolescent Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Child Adolesc Psychopharmacol. 2010 Feb;20(1):55-61. doi: 10.1089/cap.2008.0153.
Previous Dutch studies showed increasing psychostimulant use, especially methylphenidate immediate-release (MPH-IR), between 1995 and 2003. In 2003 the extended-release (ER) formulation of MPH and in 2005 atomoxetine (ATX) were introduced in The Netherlands, which increased treatment options.
The aim of this study was to describe the change in incidence of attention-deficit/hyperactivity disorder (ADHD) drugs and the prescription profiles of patients younger than 45 years starting treatment with these medicines between 2001 and 2006.
Data were obtained from Dutch community pharmacies as collected by the Foundation for Pharmaceutical Statistics, covering 97% of all dispenses for prescription medicines to outpatients in The Netherlands.
The overall incidence of ADHD drugs use increased 6.5-fold from 2001 to 2006 in men as well as in women. The absolute incidence was highest among 6- to 11-year-old boys. The percentage of first-time MPH-IR users decreased from 98.3% in 2001 to 75.9% in 2006. Likewise, MPH-ER use increased from 0% in 2001 to 18.9% in 2006, and ATX use increased from 0% in 2001 to 3.9% in 2006. The new nonstimulant drug ATX was prescribed more often to adults if they had been previously treated with selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, or antipsychotics. Youngsters <17 years initiated on ATX were often previously treated with antipsychotics or clonidine/guanfacine.
These findings demonstrate an increase in incidence in use of ADHD drugs between 2001 and 2006 in The Netherlands. The major proportion of all treated patients comprised boys, 6-11 years old; most of them were treated with MPH-IR. In a few years time, the use of extended-release drugs as part of all ADHD drug prescriptions increased considerably, despite the lack of full reimbursement of these extended-release drugs. Psychostimulants and atomoxetine in children, adolescents, and adults are probably used to address different treatment needs.
荷兰此前的研究表明，1995年至2003年间精神兴奋剂的使用呈上升趋势，尤其是速释型哌甲酯（MPH-IR）。2003年，荷兰引入了MPH缓释（ER）制剂，2005年引入了托莫西汀（ATX），这增加了治疗选择。
本研究的目的是描述2001年至2006年间45岁以下开始使用这些药物治疗的注意力缺陷多动障碍（ADHD）药物的发病率变化以及患者的处方情况。
数据来自荷兰药品统计基金会收集的荷兰社区药房数据，涵盖荷兰向门诊患者发放的所有处方药的97%。
2001年至2006年，男性和女性使用ADHD药物的总体发病率均增长了6.5倍。6至11岁男孩的绝对发病率最高。首次使用MPH-IR的用户比例从2001年的98.3%降至2006年的75.9%。同样，MPH-ER的使用从2001年的0%增至2006年的18.9%，ATX的使用从2001年的0%增至2006年的3.9%。如果成年人之前接受过选择性5-羟色胺再摄取抑制剂（SSRI）、苯二氮䓬类药物或抗精神病药物治疗，则新的非兴奋剂药物ATX更常被开给他们。开始使用ATX的17岁以下青少年之前通常接受过抗精神病药物或可乐定/胍法辛治疗。
这些发现表明，2001年至2006年间荷兰使用ADHD药物的发病率有所上升。所有接受治疗的患者中，主要是6至11岁的男孩；他们中的大多数接受了MPH-IR治疗。在几年时间里，尽管这些缓释药物没有得到全额报销，但作为所有ADHD药物处方一部分的缓释药物的使用大幅增加。儿童、青少年和成人使用精神兴奋剂和托莫西汀可能是为了满足不同的治疗需求。
