Psychotropic medication use among adolescents participating in three randomized trials of DBT

Lars Mehlum; Joan Asarnow; Sudan Prasad Neupane; Pilar Santamarina-Perez; Mireia Primé-Tous; Gabrielle A Carlson

doi:10.1186/s40479-024-00249-0

Psychotropic medication use among adolescents participating in three randomized trials of DBT

Borderline Personal Disord Emot Dysregul. 2024 Feb 22;11(1):5. doi: 10.1186/s40479-024-00249-0.

Authors

Lars Mehlum¹, Joan Asarnow², Sudan Prasad Neupane³, Pilar Santamarina-Perez⁴, Mireia Primé-Tous⁴, Gabrielle A Carlson⁵

Affiliations

¹ Institute of Clinical Medicine, Faculty of Medicine, National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway. lars.mehlum@medisin.uio.no.
² UCLA Center for Youth Suicide & Self-Harm Treatment & Prevention, David Geffen School of Medicine, UCLA, Los Angeles, USA.
³ Institute of Clinical Medicine, Faculty of Medicine, National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway.
⁴ Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR88, Barcelona, Spain.
⁵ Division of Child and Adolescent Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.

Abstract

Background: Frequently presenting with symptoms of mood or anxiety disorders, substance abuse or borderline personality disorder, suicidal and self-harming adolescents often are prescribed psychotropic medication. Though such treatment may be warranted, recurrent suicidal and self-harming behaviour is often linked to emotion dysregulation where pharmacological treatment has weak empirical support. There is a need for more clinical research into the frequency, type and rationale for pharmacological treatment in this group. In this secondary analysis of three randomized clinical trials of dialectical behaviour therapy for adolescents, we report on psychotropic medication use in the respective samples at the time of recruitment, compare use of psychotropic medication across trials and describe sample characteristics that may be associated with possible differences in psychotropic medication.

Findings: Trials were conducted in Norway, the US and Spain (labelled the Oslo, US and Barcelona samples). At baseline, 86% of the Barcelona sample, 67% of the US sample and 12% of the Oslo sample were taking at least one psychotropic medication with antidepressants as the most frequent, followed by antipsychotics (72%, 22% and 1.3% respectively) and mood stabilizers (14.2%, 16.2% and 0%). In the Oslo sample there was a significant association between receiving a diagnosis of major depression and the likelihood of receiving antidepressants, but no such association was found in the Barcelona and US samples. The overall 7-8 times higher proportion of participants in the US and Barcelona samples treated with psychotropic medication could only partially be explained by differences between the samples in diagnostic profiles, symptom severity or level of dysfunction.

Conclusions: Highly prevalent in use among suicidal and self-harming adolescents with borderline features, psychotropic medication was still very unevenly prescribed across trials, differences not explained by differences in sample characteristics suggesting that current treatment practices are not fully empirically supported. We call for continued medical education and increased availability of evidence-based psychosocial interventions.

Keywords: Adolescent; Dialectical behaviour therapy; Psychotropic medication; Self-harm; Suicide.