La prescription de médicaments psychotropes chez l’enfant et l’adolescent en France : caractéristiques et évolution entre 2010 et 2023

Abstract

Context

Questions related to the consumption of psychotropic medications among children and adolescents have garnered sustained interest in scientific literature and public debates at the international level. In France, prevalence data have not been updated since 2010. The aim of this article is to analyze the French National Health Data System Sample (ESND) to describe the trends in psychotropic medication use in the pediatric population between 2010 and 2023, as well as the various clinical, demographic, and social variables that may contribute to prescribing practices.

Methods

We conducted a systematic analysis of psychotropic medication consumption among individuals aged 0–17 in the ESND (2% of the French population) between 2010 and 2023, focusing particularly on the following drug classes: N05A antipsychotics, N05B anxiolytics, N05C hypnotics and sedatives, N06A antidepressants, N06B psychostimulants, N03 antiepileptics, and N04 antiparkinsonians.

Results

The incidence of psychotropic medication use among children and adolescents declined from 2.30% in 2011 to 2.14% in 2023. The prevalence of psychotropic medication use among those aged 3–17 rose from 3.25% in 2011 to 3.94% in 2023. More specifically, this prevalence increased from 2.32% in 2011 to 3.22% in 2023 among children aged 6–11. Among adolescents aged 12–17, it rose from 4.96% in 2011 to 5.49% in 2023. Between 2010 and 2023 the number of prescriptions per year per patient increased for most therapeutic classes, particularly for hypnotics (+137%), antidepressants (+88%), antiepileptics (+62%), antipsychotics (+50%), and psychostimulants (+40%). The duration of treatment varied significantly between therapeutic classes, being limited to one month for anxiolytics and antidepressants. Median treatment durations for other ATC classes were particularly long. The number of months of use increased by +76% between 2010 and 2023, rising from 80 months per 1000 individuals in 2010 to 138 months per 1000 individuals in 2023, with an acceleration in the period from 2021 to 2023. Poly-prescriptions were common and involved all medication classes. In 2022, 72% of psychotropic medications for children were prescribed by general practitioners, 7% by pediatricians, and 9% by psychiatrists and child psychiatrists. In 2022, 30% of children receiving at least one psychotropic prescription lived in socially disadvantaged conditions – a rate which was 50% for antipsychotics. Psychotropic medication use in children and adolescents increased during the COVID crisis and continued to rise until 2023.

Discussion and conclusion

The analysis of the ESND confirms a general increase in the prevalence of psychotropic medication use in the pediatric population, marked by a rise in the number of boxes per year per patient and a lengthening of treatment durations for many drug classes. Incidence remained stable and a slight decrease over the period, suggesting changes in prescribing practices. The rise in antidepressant and anxiolytic prescriptions since the COVID period is consistent with international data, while the continuous increase in psychostimulant use may represent a specifically French trend.