GUIDANCE-Avoidance of Psychotropic Pharmacotherapy in Children

GUIDANCE-Avoidance_of_Psychotropic_Pharmacotherapy_in_Children

Ron DeSantis Mission:

Governor To protect, promote and improve the health of all people in Florida through integrated Joseph A. Ladapo, MD, PhD state, county, and community efforts.

State Surgeon General

Vision: To be the Healthiest State in the Nation

Avoidance of Psychotropic Pharmacotherapy in Children age 5-17: Guidance Statement

July 24, 2026

The Florida Department of Health cautions health care providers in prescribing psychotropic medications to children aged 5-17 years.

Mental health challenges in children and adolescents affect immediate and long-term physical health, chronic disease, health risk behaviors, education, social interactions, and employment. Common mental health disorders among children include anxiety, depression, attention-deficit/hyperactivity disorder, and behavioral disorders. According to the National Health Interview Survey (2021):

• 14.9% of children aged 5-17 years reported having mental health treatment in the past 12 months
• 8% of children aged 5-17 years reported taking medication as part of their mental health treatment in the past 12 months
• 11.5% of children aged 5-17 years reported receiving therapy/counseling as part of their mental health treatment in the past 12 months Research on psychotropic medication prescriptions in children younger than 18 by provider type found that over half were prescribed by general practitioners (42.9%), nurse practitioners/physician assistants (12.2%), or other medical doctors (7.2%) (Hughes, 2024).

Concerning trends in the prescription of psychotropic drugs necessitate a clear process for clinically appropriate medication administration, monitoring, and oversight. Many psychotropic medications do not have FDA-approved labeling for children. The long-term adverse effects of psychotropic medication use in children are not well understood (Anderson, 2004).

Children often do not receive efficient evaluations of environmental stressors or undergo behavioral therapy prior to beginning pharmacotherapy (AACAP, 2017).

The State Surgeon General recommends against the use of psychotropic drugs in children for treatment of mental health conditions such as depression, anxiety, or attention-deficit related disorders. Health care providers should consider employing the following strategies in children to decrease psychotropic drug administration:

• Perform comprehensive evaluations before beginning treatment for a mental or behavioral disorder. Except in the case of an emergency, a child should receive a thorough health history, psychosocial assessment, mental status exam, and physical exam before initiating a treatment plan. Evaluating behaviors such as unstructured play is part of a comprehensive assessment of social, emotional, cognitive, language, and self-regulation skills (Yogman, 2018). Assessment of patient sleep hygiene and electronic screen behaviors is also recommended. Florida Department of Health Office of the State Surgeon General Accredited Health Department 4052 Bald Cypress Way, Bin A-00 • Tallahassee, FL 32399-1701 Public Health Accreditation Board PHONE: 850-245-4210 FloridaHealth.gov

• Complete a full physical examination to include laboratory tests for nutritional disorders, endocrine disorders, heavy metals, mold exposure, and blood disorders before prescribing any medication. Other medical tests may also be recommended such as electrocardiogram or electroencephalogram (AACAP, 2017).
• Begin psychotherapy before considering prescribing psychotropic medication. In cases of mild presentation, psychotherapy or environmental changes are generally recommended prior to pharmacotherapy.
• Offer parents training in evidence-based behavior management which may include regular physical activity (Recchia, 2023), dietary interventions such as reducing intake of processed foods (Firth, 2019), sugar, artificial ingredients, and substantially reducing screen time (Santos, 2023).
• Deprescribing supports the patient-centered treatment plan. When deprescribing, health care providers must consider risks associated with the individual drug and the cumulative risk from multiple drug interactions (Scott, 2015). Medication discontinuation may need to be gradual depending upon length of use (Horowitz, 2023). Medication should not be stopped abruptly. References

American Academy of Child and Adolescent Psychiatry (AACAP). 2017. Psychiatric Medication for Children and Adolescents Part I- How Medications are Used. No. 21; July 2017. aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF- Guide/Psychiatric-Medication-For-Children-And-Adolescents-Part-I-How-Medications-Are-Used-021.aspx.

Andersen SL, Navalta CP. (2004). Altering the course of neurodevelopment: a framework for understanding the enduring effects of psychotropic drugs. International Journal of Developmental Neuroscience. 2004 Aug-Oct;22(5-6):423-40. doi: 10.1016/j.ijdevneu.2004.06.002.

Bitsko RH, Claussen AH, Lichstein J, et al. Mental Health Surveillance Among Children-United States, 2013-2019. MMWR Suppl 2022;71 (Suppl-2):1-42. Doi: dx.doi.org/10.15585/mmwr.su7102a1.

Center for Medicare and Medicaid Services. 2015. Antidepressant Medications: Use in Pediatric Patients. US Department of Health and Human Services. October 2015. cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/pharmacy-education-materials/downloads/ad-pediatric-factsheet11-14.pdf.

Firth, J., Marx, W., Dash, S., Carney, R., Teasdale, S. B., Solmi, M., Stubbs, B., Schuch, F. B., Carvalho, A. F., Jacka, F., & Sarris, J. (2019). The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosomatic medicine, 81(3), 265–280. doi.org/10.1097/PSY.0000000000000673.

Horowitz MA, Jauhar S, Natesan S, Murray RM, Taylor D. (2021). A method for tapering antipsychotic treatment that may minimize the risk of relapse. Schizophora Bulletin. 2021;47(4):1116-1129. Published correction appears in Schizophora Bulletin. 2023;49(2):533. doi:10.1093/schbul/sbab017

Hughes PM, Annis IE, McGrath RE, Thomas KC. 2024. Psychotropic Medication Prescribing Across Medical Providers, 2016- 2019. Psychiatric Services. 2024 May 1;75(5):477-480. doi: 10.1176/appi.ps.20230156.

Recchia F, Bernal JDK, Fong DY, Wong SHS, Chung PK, Chan DKC, Capio CM, Yu CCW, Wong SWS, Sit CHP, Chen YJ, Thompson WR, Siu PM. 2023. Physical Activity Interventions to Alleviate Depressive Symptoms in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatrics. 2023 Feb 1;177(2):132-140. doi: 10.1001/jamapediatrics.2022.5090. pubmed.ncbi.nlm.nih.gov/36595284/.

Santos RMS, Mendes CG, Sen Bressani GY, de Alcantara Ventura S, de Almeida Nogueira YJ, de Miranda DM, Romano- Silva MA. 2023. The associations between screen time and mental health in adolescents: a systematic review. BMC Psychology. 2023 Apr 20;11(1):127. doi: 10.1186/s40359-023-01166-7.

Scott, IA et. al. 2015. Reducing Inappropriate Polypharmacy: the Process of Deprescribing. JAMA Internal Medicine 2015; 175(5); 827-34.

Yogman M, Garner A, Hutchinson J, Hirsh-Pasek K, Golinkoff RM; 2018. Committee on psychosocial aspects of child and family health; Council on communications and media. The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics. 2018 Sep;142(3):e20182058. doi: 10.1542/peds.2018-2058.