Psychotropic prescribing and GP involvement among Belgian youth: a national database 2018-2023

Abstract Background Psychotropic medication use among children and young adults has increased in Belgium, but prescribing patterns and prescriber roles remain understudied. Current guidelines discourage first line providers, general practitioners (GPs) and pharmacists, from prescribing these drugs to youth. We examined age related variation in prescribing by drug class and prescriber type (GP vs. specialist). Methods Using the Belgian Farmanet database of reimbursed pharmaceutical products, we extracted defined daily doses (DDDs, 2018-2023) and primo prescriptions (2021-2023, reference year 2020) for individuals aged 0-24 years across 5 ATC classes: baclofen (M03BX01), gabapentinoids (N02BF), antipsychotics (N05A), antidepressants (N06A), and psychostimulants (N06B). Logistic regression assessed the effect of age group (0-9 as reference) on the likelihood of receiving a GP prescription. Results Antidepressants accounted for the largest share of DDDs (49.3%). GP involvement varied across drug classes: 63.8% of baclofen DDDs were prescribed by GPs, followed by antidepressants (58.3%), gabapentinoids (54.6%), antipsychotics (45.2%), and psychostimulants (26.8%). For all classes, GP prescribing increased significantly with age, and specialists’ share declined. For instance, GP's share of antidepressant prescriptions rose from 33.6% (0-9) to 64.9% (20-24), with odds ratios (ORs) of 0.92, 1.92, and 3.68 for the 10-14, 15-19, and 20-24 age groups, respectively. For psychostimulants, GP prescribing increased from 23.8% to 52.3% (ORs: 1.16, 1.24, 3.52). Primo prescriptions data showed comparable trends: antidepressant prescribing by GPs rose from 34.8% to 64.0% (ORs: 1.14, 2.37, 3.34); for psychostimulants, from 29.9% to 54.3% (ORs: 1.17, 1.39, 2.79). Conclusions In Belgium, psychotropic prescribing in youth increasingly shifts from specialists to general practitioners with age. Contrary to guidelines, this trend holds across both overall prescribing (DDD) and primo prescription. Key messages • GPs play a prominent role in prescription of psychotropic drugs among youth. Across all drug classes, GP involvement in prescribing rose significantly with age in both DDD and prescription initiation. • GPs play a significant role in prescribing psychotropic drugs, whilst specialists remain central. Understanding prescribing drivers in general practice is key to improve guidelines’ implementation.