Karanges Emily A, Stephenson Chris P, McGregor Iain S
School of Psychology, University of Sydney, Sydney, Australia.
School of Psychology, University of Sydney, Sydney, Australia
Aust N Z J Psychiatry. 2014 Oct;48(10):917-31. doi: 10.1177/0004867414538675. Epub 2014 Jun 13.
Longitudinal trends in the dispensing of antidepressant, antipsychotic and ADHD medications from 2009-2012 were examined according to age and gender of patient and prescriber speciality. Of particular interest were changing trends in the prescription of psychotropic medications to children, adolescents and young adults.
Dispensing data for government-subsidised antidepressant, antipsychotic and ADHD medications were obtained from the database maintained by the Department of Human Services. Results were expressed in terms of number of prescriptions dispensed.
Over the four- year study period, the dispensing of antidepressants, antipsychotics and ADHD medications showed overall increases of 16.1%, 22.7% and 26.1% respectively. The most rapid percentage increases in antidepressant and antipsychotic dispensing occurred in children aged 10-14 (35.5% and 49.1% respectively), while ADHD medication dispensing rose most rapidly in those aged 20-24 (70.9%). Dispensing to males was more common during childhood for all investigated classes while two-thirds of adult antidepressant prescribing was to female patients. The most commonly prescribed antidepressants varied by age and were as follows: fluoxetine (3-19 year olds), desvenlafaxine (20-24 years) and venlafaxine (>25 years). Risperidone was the most common antipsychotic dispensed to children under 15, quetiapine to adolescents and young adults (15-24 years), and olanzapine to adults. Methylphenidate was the most common ADHD medication in those aged under 25, and dexamphetamine the most common in adults. Most antidepressants and antipsychotics were prescribed by GPs (89.9% and 70.6% respectively), while the majority of ADHD medications were prescribed by paediatricians (59.1%).
Dispensing of psychotropic medications increased markedly from 2009 to 2012, with notable age-specific trends. General adherence to treatment guidelines is apparent, yet concerns exist regarding rapid increases in serotonin noradrenaline reuptake inhibitor (SNRI) antidepressant prescribing, the likely overmedication of persons with mild psychological distress, and the increasing use of powerful psychotropic medications in younger populations despite uncertain risk-benefit profiles.
根据患者的年龄和性别以及开处方医生的专业，研究2009年至2012年期间抗抑郁药、抗精神病药和注意力缺陷多动障碍（ADHD）药物的配药纵向趋势。特别令人感兴趣的是向儿童、青少年和年轻成年人开具精神药物处方的变化趋势。
从人类服务部维护的数据库中获取政府补贴的抗抑郁药、抗精神病药和ADHD药物的配药数据。结果以配药处方数量表示。
在为期四年的研究期间，抗抑郁药、抗精神病药和ADHD药物的配药分别总体增加了16.1%、22.7%和26.1%。抗抑郁药和抗精神病药配药增长最快的是10至14岁的儿童（分别为35.5%和49.1%），而ADHD药物配药增长最快的是20至24岁的人群（70.9%）。在儿童期，所有调查类别的药物向男性配药更为常见，而成年抗抑郁药处方的三分之二是开给女性患者的。最常开具的抗抑郁药因年龄而异，如下所示：氟西汀（3至19岁）、去甲文拉法辛（20至24岁）和文拉法辛（>25岁）。利培酮是给15岁以下儿童配药最常见的抗精神病药，喹硫平是给青少年和年轻成年人（15至24岁）配药最常见的，奥氮平是给成年人配药最常见的。哌甲酯是25岁以下人群最常见的ADHD药物，右苯丙胺是成年人最常见的。大多数抗抑郁药和抗精神病药由全科医生开具（分别为89.9%和70.6%），而大多数ADHD药物由儿科医生开具（59.1%）。
从2009年到2012年，精神药物的配药显著增加，有明显的年龄特异性趋势。对治疗指南的总体遵守情况明显，但存在以下担忧：5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）抗抑郁药处方的快速增加、轻度心理困扰者可能用药过度，以及尽管风险效益情况不确定，但年轻人群中强效精神药物的使用不断增加。
