Pharmaco-epidemiology: What do (and don't) we know about utilisation and impact of psychotropic medications in real-life conditions?

An example of a potentially hazardous extension of indication can be drawn from community surveys showing that a large percentage of children and adolescents treated with psychostimulant drugs do not fulfil the diagnostic criteria for attention-deficit hyperactivity disorder (Rey & Sawyer, 2003). [...]it is striking that interest in early intervention markedly increased when new antipsychotic drugs became available, and the enthusiastic support of early intervention programmes by pharmaceutical companies suggests that they at least have little doubt about the benefits they can obtain from this strategy. Sparse findings suggest that exposure to xenoestrogens such as diethylstilbestrol may be a risk factor for psychiatric disorders, mediated by a possible deleterious impact of these substances on foetal neurodevelopment, but this hypothesis is speculative owing to the small number of studies and their methodological limitations (Verdoux, 2002). Pharmaco-epidemiological research conducted independently of drug companies is therefore required to explore crucial public health issues related to psychotropic drug use, such as the medical and economic impact of unjustified extension of use, the identification of infrequent or delayed adverse effects, and the efficiency of new marketed products in naturalistic conditions.