A new study finds pediatric polypharmacy -- prescribing two or more psychotropic medications to treat children -- in on the rise. But there is little scientific research to support this very common clinical practice.

It is not unusual for children to be on a combination of stimulant medication for ADHD (attention-deficit/hyperactivity disorder) and an anti-depressant or anti-psychotic medication. That is according to a research review led by child psychologist Dr. Joseph Penn of Brown Medical School in Rhode Island. He says there is considerable pressure on mental health professionals and primary-care physicians to prescribe.

"There's unfortunately a lot of pressure from -- I would say market pressure -- from insurance companies to ratchet down health care, so there's more pressure for shorter lengths of stay in the hospital," Penn notes. "And there's less available resources in the community like intensive treatment programs, outpatient day treatment, other crisis services."

In addition, says Penn, there are more medications available now than five or ten years ago, as well as more marketing of the medications by pharmaceutical companies directly to consumers and physicians. One of the results, as he points out in his review, is that children diagnosed with behavioral and psychiatric disorders are increasingly being prescribed with two or more psychotropic drugs at the same time. The most frequent combination the study found included stimulants such as Ritalin, Dexedrine, and Adderall -- common treatments for ADHD -- used along with other psychotropic medication.

Dr. Penn says before giving their children behavior medications, parents need to ask their children's physician several questions, including whether the drug is approved by the Food and Drug Administration -- and if so, for what conditions.

"Is it approved for use in children, specifically in adolescents?" is the second question he suggests asking. "Three would be: What are the short and long-term risks and benefits of the medication? Four would be: Could there be any interaction to the medication with other medicines kids are often on -- medicines for acne or asthma or allergies or other conditions?"

Additional questions he encourages parents to ask are: How long will the child need to be on the medication? And what are the side effects that should be reported back to the doctor?

Penn recently told HealthDay News that it is not uncommon to find a child on an antidepressant, a mood stabilizer, and a sleep agent all at the same time. "If there is so much concern over the effects of a single drug, how much riskier is it to prescribe multiple drugs?" he wonders. His study is published in this month's issue of Psychiatry 2005.


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