Off-label prescribing of psychotropic medications has become a common practice among children and adolescents in mental health. In a study conducted in Denmark, “32.3% of all prescriptions were off-label, and 41.6% of subjects received at least 1 off-label prescription. The off-label rates for each drug class were as follows: melatonin, 100%; antipsychotic agents, 95.6%; benzodiazepines, 72.5%; antidepressants, 51.1%; and ADHD medication, 2.7%.” While most medications match the diagnosis and behaviors, this is not always the case. Frequently, psychiatrists may treat youth with an off-label medication. Yet the youth, caregiver, and others may not understand the implications of their prescription.
What is off-label prescribing of psychotropic medications and how does it affect youths? The definition of an off-label prescription is that the psychiatrist uses the drug for a reason for which it was not clinically tested. For example, when pharmaceutical companies get FDA approval for medicines, they state the medication’s purpose. Examples are Adderall for attention problems, Lexapro for depression, or Lithium for bipolar disorder. Several phases of clinical trials occur to prove the drug is both safe and effective for the stated purpose. After approval, the drug is ready for a prescription.
But suppose a psychiatrist sees a paper in a journal that explains the effectiveness of a drug for another purpose. Or the pharmaceutical rep who visits their office gives them a brochure about new uses for the drug. The psychiatrist can use that drug for something else if they feel it is effective.
So is off-label prescribing of psychotropic medications helpful to clients?
The reason many psychiatrists use off-label prescribing is the time and expense of approval for an additional purpose. The pros to it are that psychiatrists in clinical practice may see treatments that pharmaceutical companies cannot. They’re “closer to the action” and know which medications work and which don’t. They can use medications now instead of waiting years for the FDA approval.
The cons are that without the rigor of clinical trials, psychiatrists don’t know the safety or effectiveness of medications or have the clinical knowledge of the medication. And many psychiatrists receive information about medications from pharmaceutical representatives, not from medical journals.
What is the final answer regarding off-label prescribing of psychotropic medications? Tell your caregivers to be informed, ask about off-label prescriptions and their effectiveness, and get second opinions if they’re not sure. They can work, but it’s best to have some hard data first.
Praxes offers an online course in psychotropic medications.
For more information about our training courses, please contact us.
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PRAXES is a nationwide behavioral health software, consulting, and training company. No one in the behavioral health industry has a better reputation, and if you give us the chance, we’ll show you why! At PRAXES, our services improve the efficiency and structure of behavioral health agencies serving children and families nationwide. PRAXES brings over 45 years of administrative and clinical expertise. With more than 100 client companies nationwide, we offer the expertise to advance the quality of behavioral health services. We accomplish these goals through our new clinical decision software, our training of best practices, and helping companies meet regulatory standards. At PRAXES, we believe in being creative and fostering new ways to serve children and their families. Our vision is to empower the families our agencies serve with skills that not only improve their functioning, but help them to thrive in their everyday lives. When you give us the chance, you’ll be connected directly to our friendly staff, so you can expect immediate attention to your inquiry. So, don’t wait, call now!
Dan Thorne has unique perspectives on the field of mental health. As a clinician, he has had over 40 years of experience working with clients in the Southern California area. After obtaining his Bachelor’s degree from the University of California at Irvine, he worked with children in the Orange County Juvenile Hall. Here he honed his earliest techniques on at-risk children. After that, he obtained his Master’s degree in Counseling from California State University, Fullerton.
In the 1990’s, Dan turned his attention to the clinical and administrative side of behavioral health organizations. For three years, he was the Assistant Administrator of Starting Point, a chemical dependency facility in Costa Mesa, CA. In 2001, he took an opportunity to be the Director of Harbor View Community Services Center in Long Beach. When he arrived, the Center had only 80 clients and 13 staff. When he left, there were over 400 clients and 75 staff. Dan created several programs through their contract with the Los Angeles County Departments of Mental Health and Child and Family Services. Under his guidance, Harbor View became one of the leading providers of children’s services in Los Angeles County.
While improving the results of the client’s parents at the Center, Dan reflected on his experiences as a parent. His children themselves had special needs such as mental and intellectual challenges, and Dan knew the toll it takes on the parent. In order to help the child, the parent has to be healthy. From this concept, he created his parenting program. After years of refining it, teaching it to his staff at the Center, and then taking the results and comments from these efforts, he became the developer of the current PRAXES program. It is a culmination of Dan’s personal trials and tribulations as a parent along with empirical results and research of over 40 parenting programs.
Our vision at PRAXES is to advance the strength of parents and caregivers of children with special needs (mental health, intellectual, or physical) through education, support, and empowerment. Thus, they can live healthy and functional lives while caring for the child.
Apogee is a clinical decision software designed to help behavioral health practitioners with their treatment and patient engagement. It provides evidence-based and research-based components. Not only do they consist of elements from such practices as Cognitive Behavior Therapy, Seeking Safety, Dialectical Behavior Therapy, Motivational Interviewing, Functional Behavior Analysis, but also the Intensive Models for Parents, Youth, and Children.
PRAXES has over 30 years of accreditation experience. We know what it takes to get your organization accredited. Whether it’s Joint Commission, CARF, or COA, our team can provide an evaluation of your current status and review the standards which need improvements. We will assist you with the policies, documentation, and training required to be accredited.
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