A study published online today in the journal Child and Adolescent Psychiatry and Mental Health finds that American children are three times more likely to be prescribed antidepressants and stimulants for conditions such as ADHD and bipolar disease than children in Europe.

The study, which looked at insured kids and teens in the Netherlands (110,944), Germany (356,520), and the U.S. (127,157), found that 6.7% of American kids are taking psychotropic medications, compared with 2.9% of kids in the Netherlands and 2% of those in Germany.

Use of psychotropic drugs in the U.S. was 2.27 higher than in the Netherlands and 3.33 times higher than in Germany.

Antidepressant and stimulant prevalence were three or more times greater in the United States than in the Netherlands and Germany. Antipsychotic prevalence was 1.5 to 2.2 times greater in the U.S. than in the Netherlands and Germany, the study found. Other psychotropic medications such as alpha agonists, lithium, antiparkinsonian agents, anxiolytics, hypnotics, and anticonvulsant mood stabilizers were rarely prescribed.

“There is significantly greater use of atypical antipsychotics and SSRI-type antidepressants for child mental health treatment in U.S. than in Western Europe,” said lead researcher Julie Zito, from the pharmaceutical health services research department in the School of Pharmacy at the University of Maryland.

Over the past decade, prescriptions for psychotropic drugs have been rising across western Europe and in the U.S., according to the study.

The researchers said the differences may be due to regulatory practices, differences in policies related to direct-to consumer drug advertising, diagnostic classification systems, and cultural beliefs regarding the role of medication for emotional and behavioural treatment. For example, in the United States, there are more diagnoses of bipolar disease among children and adolescents than there are in Europe, the researchers noted.

Other studies showed that antidepressants use declined among teens after drugmakers added prominent warnings about the risk of side effects such as suicidal thoughts to the prescribing information for all antidepressants in 2004, following the request of the Food and Drug Adminstration. But in 2004, when the FDA released the new rules, he youth suicide rate increased by 18%. The black-box warning for antidepressants mentioned that the drugs could increase suicidal thoughts and behaviours among teens.