Pediatric Stimulant and Selective Serotonin Reuptake Inhibitor Prescription Trends

BACKGROUND: Presciption trends have key implications for costs, outcomes, and research, yet few data exist on pediatric selective serotonin reuptake inhibitor (SSRI) trends and associations with stimulant trends. OBJECTIVE: To describe prescription trends for stimulants, SSRIs, and combination prescriptions by age, sex, and race. METHODS: Retrospective population-based analysis of North Carolina Medicaid prescription claims files. PARTICIPANTS: North Carolina Medicaid recipients, 1992 through 1998, aged 1 to 19 years. The population ranged from 342 333 children in 1992 to 581 088 in 1998. MAIN OUTCOME MEASURES: Annual number of prescriptions, patients filling a prescription claim, and prescription prevalence for stimulants and SSRIs. RESULTS: The number of children and adolescents who received stimulants increased from 6407 (24 584 claims) in 1992 to 27 951 (135 057 claims) in 1998. The number of SSRI recipients increased from 510 children (1326 claims) in 1992 to 6984 children (25 392 claims) in 1998. Prescription prevalence in school-aged children 6 to 14 years increased from 4.4% to 9.5% for stimulants during the study period, and from 0.2% to 1.5% for SSRIs. In 1998, stimulant prescription prevalence was highest for white school-aged males (18.3%) vs black females (3.4%) and SSRI prescription prevalence was highest for white school-aged males (2.8%) vs black females (0.6%). Combination pharmacotherapy also increased during 1992 through 1998. CONCLUSIONS: Prevalence of stimulant and SSRI medications has increased during the 1990s, with prescription prevalence in North Carolina Medicaid youth higher than previously reported. Age, sex, and racial differences are apparent and call for further attention. Combination pharmacotherapy also has growing importance.