title: Extent, Time Course, and Moderators of Antipsychotic Treatment in Youth With Mood Disorders: Results of a Meta-Analysis and Meta-Regression Analyses.
abstract: OBJECTIVE
  To meta-analytically examine the trends and correlates of antipsychotic use in youth with mood disorders.
  
  
  METHODS
  Systematic literature search without language restriction in PubMed/MEDLINE/PsycINFO from database inception through March 2015 using the following search terms: (antipsychotic* OR neuroleptic* OR "dopamine blocker*" OR antidopaminergic) AND (child* OR adolescen* OR pediatric OR youth) AND (prescription* OR prescrib* OR use OR utilization OR database OR pharmacoepidemiolog* OR frequency OR rate OR rates). Random effects meta-analysis and meta-regression analyses were conducted.
  
  
  METHODS
  Included were studies reporting on the frequency of (1) mood disorders in antipsychotic-treated youth (≤ 19 years) and (2) antipsychotic use in youth with mood disorders.
  
  
  METHODS
  Two independent investigators abstracted data on study, patient, and treatment characteristics.
  
  
  RESULTS
  Forty-one studies were meta-analyzed (N = 518,919, mean ± SD age = 12.8 ± 1.8 years, males = 65.7%). Altogether, 24.2% of antipsychotic-treated youth had a mood disorder diagnosis (studies = 34, depression spectrum disorder = 10.9%, bipolar spectrum disorder = 13.6%). In longitudinal studies, the overall proportion increased significantly from 17.3% in 2000 (range, 1996-2009) to 24.5% in 2006 (range, 2004-2011) (odds ratio [OR] = 1.50; 95% confidence interval [CI], 1.26-1.79; P < .0001). This increase was driven entirely by bipolar spectrum diagnoses (2001 = 11.1%, 2006 = 16.3%, P < .0001), rather than depression spectrum diagnoses (2001 = 9.1%, 2007 = 9.2%, P = .77). Among youth with mood disorders (8 studies), 24.0% received antipsychotics (depression spectrum disorder = 4.6%; bipolar spectrum disorder = 44.0%).
  
  
  CONCLUSIONS
  The proportion of youth with mood disorder diagnoses increased significantly among antipsychotic-treated youth, driven entirely by an increase in youth with bipolar spectrum disorders. Progress in understanding the reasons for these trends and for an evaluation of the appropriateness of the observed antipsychotic prescribing requires more detailed information than is available in traditional pharmacoepidemiologic databases.
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy.|Department of Pediatrics, University of Padua, Italy.|The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, New York, USA.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cervesi
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.
authors.forename: Su Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.
authors.forename: Britta
authors.initials: B
authors.lastname: Galling
authors.affiliation: University of Pavia, Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, Pavia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Molteni
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masi
authors.affiliation: Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.|Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gerhard
authors.affiliation: New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, 75-59 263rd St, Glen Oaks, New York 11004. ccorrell@northwell.edu.|The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.|Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA.|The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence, Manhasset, New York, USA.|Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, New York, USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D002648:Child; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D056687:Off-Label Use; D012044:Regression Analysis
chemical_list: D014150:Antipsychotic Agents