More kids getting multiple drugs for mental ills

The practice of prescribing multiple medications to treat mental conditions in children and adolescents has increased over the last decade, results of a medical review suggest.

However, research into this "polypharmacy" treatment strategy has failed to keep pace with practice, leaving open the potential for serious side effects.

"Drug augmentation therapy is common clinical practice among adults," said study co-author Dr. Joseph V. Penn, and there has been a "trickle-down effect" to children and adolescents - despite the absence of scientific research.

Penn and his associates at Brown Medical School in Providence, Rhode Island, searched for medical studies published from 1994 to 2004 regarding polypharmacy in child psychiatry in the US. According to their report in the journal Psychiatry, they found a "universal increase" in the use of polypharmacy.

Common combinations were antidepressants and antipsychotics, stimulants and antidepressants, stimulants and clonidine, and antidepressants and clonidine.

"A lot of families want that quick fix so medication tends to be the go-to thing," Penn said.

Other factors putting pressure on doctors to prescribe drugs include increased drug advertising, both to consumers and to physicians; increased pressure to shorten hospital stays; lack of time on the part of primary care providers to adequately evaluate the patient; and the shortage of specialists in child psychiatry.

Sometimes medication simply isn't the best treatment for the problem, Penn said. "Maybe the kid is being teased or bullied at school or there was a recent break-up, stressors that don't necessarily respond to medications," he pointed out.

It's also "an informed consent issue," he added. "Youths and families need to be educated about the potential risks and benefits and alternatives, and to consider counseling or other psychosocial treatment with or without medication."

Penn conclude, "The bottom line is that we need more research into psychotropic medications for kids, especially using ... meds in combination."

SOURCE: Psychiatry, August 2005.