Researchers have said that U.S. children are three times more likely to be prescribed psychotropic medications for conditions such as ADHD and bipolar disease ass compared to European children. This dramatic difference, the researchers feel could be explained by the differences in regulatory practices as well as cultural beliefs about the benefit of medication for emotional and behavioral problems.

The study, published in the journal ‘Child and Adolescent Psychiatry and Mental Health’, looked at the use of antidepressants such as Prozac and stimulants such as Ritalin in the United States, the Netherlands and Germany.

Lead researcher Julie Zito, from the pharmaceutical health services research department in the School of Pharmacy at the University of Maryland said, "There is significantly greater use of atypical antipsychotics and SSRI-type antidepressants for child mental health treatment in U.S. than in Western Europe. Since most of the use is 'off-label' -- without adequate evidence of benefits and risks, close monitoring should be considered when these medications are used."

The researchers say they found the annual prevalence of psychotropic medications among children in the United States to be significantly higher than either in Germany or the Netherlands. 6.7 % of the children in the United States were taking these drugs as compared with 2.9 % in the Netherlands and 2 % in Germany. "Antidepressant and stimulant prevalence were three or more times greater in the United States than in the Netherlands and Germany, while antipsychotic prevalence was 1.5 to 2.2 times greater," Zito said.

The reasons for this discrepancy, the researchers feel could partly be due to differences in the diagnosis systems. Bipolar disease is diagnosed more in the United States among the children and adolescents than it is in Europe. Also the United States has a larger per capita number of child psychiatrists than in Europe and a number of children in the United States are taking two or more psychotropic drugs in a single year.

"The U.S. trend of increasing bipolar diagnosis in children and adolescents does not reflect European practice," said the study authors in a statement. "Government cost restrictions in Europe, the larger number of child psychiatrists per capita in the United States and the use of two or more different psychotropic drugs in a single year in U.S. children are possible explanations.” "Direct-to-consumer drug advertising, which is common in the U.S., is also likely to account for some of the differences. The increased use of medication in the U.S. also reflects the individualist and activist therapeutic mentality of U.S. medical culture," the researchers concluded.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine said, "It has been said many times that the U.S. has a sick-care system, rather than a health-care system, with a particular emphasis on use of drugs and procedures for diagnosed conditions. This study reaffirms that pattern, with more use of medication for various mental health conditions among children in the U.S than other countries."

He felt this study was unable to show whether the use of medication was appropriate, given variations in culture, or whether other countries under-prescribe psychotropic drugs or whether the U.S. over-prescribes them, Katz added.

"To make that determination, a comparison of outcomes associated with these differing practice patterns is required," Katz said. "The value in comparing and contrasting resides ultimately in gaining insights about best practices. We now know that practices vary, but don't know which pattern, if any, is demonstrably superior to the others."