Increasing Numbers of Children Prescribed Multiple Psychiatric Medications

Despite the heightened risk and little evidence of benefit, children are increasingly being prescribed multiple psychiatric drugs.

Peter Simons
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According to researchers, children are increasingly prescribed multiple different psychiatric medications (a practice known as polypharmacy). The use of antipsychotics in children has grown significantly since 1999. Most concerningly, even children between the ages of 0-4 are receiving polypharmacy regimens.

“The use of medication from 2 or more psychotropic classes, i.e., polypharmacy, has increased among US youths despite limited evidence of efficacy and mounting safety concerns,” the researchers write.

The study was led by Chengchen Zhang at the University of Maryland and published in JAMA Pediatrics. They used the Medical Expenditure Panel Survey (MEPS), a large household survey intended to be a nationally representative sample. The researchers divided their assessments into three time periods to draw comparisons over time: 1999-2004; 2005-2010; and 2011-2015.

“The number of US youths treated with psychotropic polypharmacy increased from 101,836 (1999-2004) to 222,955 (2005-2010) to 293,492 (2011-2015),” Zhang writes—an increase of over 180%.”

In the group of children prescribed polypharmacy regimens, antipsychotics increased from 38.3% of the children in 1999-2004 to 75% of the children in 2011-2015. The percentage of children prescribed mood stabilizers decreased from 61.2% to 37.98% over the same time period. Antidepressant use fell slightly, from 71.3% at the first time point to 64.2% in the most recent measurement.

The most common drug class being prescribed, though, was stimulants (such as Adderall and Ritalin), which peaked in the 2005-2010 time period at 82.1% before falling slightly to 78.1% most recently.

At all time points, the most common diagnosis among children prescribed polypharmacy regimens was ADHD. At the most recent time point, over 85% of the children taking multiple drugs had a diagnosis of ADHD. The next most common diagnosis was mood disorders (which include depression and bipolar disorder)—60% at the most recent time point. Despite the prevalence of antipsychotic prescriptions, only 1% of the children had a diagnosis of schizophrenia.

This diagnostic trend may reflect the increasing prevalence of bipolar disorder diagnoses in children, which experts say has been over-diagnosed. The increasing prevalence of bipolar diagnoses may also be caused by the mania-inducing effects of stimulant drugs (used for ADHD treatment), which could account for the overlap of children with ADHD and mood disorder diagnoses. Antidepressants can also cause mania, which may lead to further prescriptions of mood stabilizers or antipsychotics.

In 1999-2004, no children between the ages of 0-4 were identified as being prescribed multiple psychiatric medications. The same held true for the 2005-2010 time point. However, by the latest time point, 1.3% of the children being prescribed polypharmacy regimens were between the ages of 0-4. This signifies a growing trend of prescribing multiple psychiatric drugs to infants and toddlers.

Children were more likely to be prescribed three medications than two—at the most recent time point, 38% were on two medications, but 62% were on three.

The most common combinations of drugs at the most recent time point were as follows:

  1. Antipsychotics, stimulants, and α-agonists (21.8%)
  2. Antipsychotics, antidepressants, and stimulants (16.7%)
  3. Antidepressants, stimulants, and α-agonists (13.9%)
  4. Antipsychotics, antidepressants, and mood stabilizers (9.9%)

The researchers note that there is limited evidence for the benefit of polypharmacy and increasing recognition of the harms, which increase as more medications are added. They add that in the future, “Evidence of the efficacy and safety is needed to guide psychotropic polypharmacy practices.”

 

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Zhang, C., Spence, O., Reeves, G., & dosReis, S. (2020). Characteristics of youths treated with psychotropic polypharmacy in the United States, 1999 to 2015. JAMA Pediatrics. Published online November 2, 2020. DOI: 10.1001/jamapediatrics.2020.4678 (Link)

14 COMMENTS

  1. This is incredible, possibly the best summation of this problem;

    “The increasing prevalence of bipolar diagnoses may also be caused by the mania-inducing effects of stimulant drugs (used for ADHD treatment), which could account for the overlap of children with ADHD and mood disorder diagnoses. Antidepressants can also cause mania, which may lead to further prescriptions of mood stabilizers or antipsychotics.”

    Kid gets strung out on ritalin > winds up on neuroleptics > now he’s a zombie > here comes anti-depressants – oops now he’s gone manic or become irritable or obsessive > more neuroleptics

    Especially in regards to my own case, I can sum up child psychiatry this way;

    Fuck a child up on amphetamines, turn him and his parents life into a disaster; now claim he’s ill and it’s only your profession that can properly treat him. What a way to get paid. Cozy up with the schools and child protective services, department of health and human services and social services, and turn it into an atrocity. This happened to me. Unless they found another way to do it (I’m sure they’ve found numerous ways by now) then this is still going on.

    • Glad to see you keep talking about this Jeffrey.
      It would be great if you could get child survivors together. Place ads.
      Local papers, craig’s list or wherever. And perhaps start a fund page,
      where a lot of people are watching over the funds.
      Use those funds for a lawsuit. Perhaps some critical psychiatry people
      to support the efforts in court.

      • I’m really afraid of what I may find. An investigator should look into how many “young” under 40 Americans are living in group homes. That would be a start. When I was at hawthorn state mental hospital in michigan at age 13, I narrowly avoided being sent to a group home. If that had happened, I wouldn’t be here.

        And then there’s the stain of abuse. I know at times I tried to accept what happened to me as a blunder at worst and move on with my life. And then of course there’s the abusive parents who stuck their kids in the psychiatric system in the first place, and are keeping them there.

        I imagine that the only way things will change is if a small number of powerful and important people decide to do something about this. As an observer, I’m not all that enthusiastic about grassroots and protesting, etc. It just doesn’t work. A million peasants demanding justice is just a million peasants demanding justice. They can be ignored, or humored; no consequence for the people in power. Just look at what happened to Justina Pelletier.

  2. Thank you Peter.

    There is insanity. A society that uses neurotoxins on children, that is the true insanity. It is a legal form of changing brains. Governments that allow this are insane. And they are changed to further disability and disability is keeping an economy going.
    The Nazi doctors were insane.

  3. “α-agonists” – What are these drugs? Is there a more commonly known name?

    “Evidence of the efficacy and safety is needed to guide psychotropic polypharmacy practices.”

    Especially since evidence of the harms is taught to every med student in med school. Given the fact all doctors are taught in med school about the harms caused by combining the anticholinergic drugs, like the antidepressants and antipsychotics.

    https://en.wikipedia.org/wiki/Toxidrome

    Since combining those drug classes can create “psychosis” and “hallucinations,” via anticholinergic toxidrome. A medically known way to poison people, that is missing from the DSM – the “bible” of psychiatry, whose adherents, are absolutely obsessed with “psychosis.”

  4. Last night would discover through local library, Kanopy video, “Unmistaken Child”, about the Buddhist concept of reincarnation. The idea of sentience is quite important and at odds with the pharma story referenced above. With context also to a reading of InDeed, about Divine Wisdom in the chapter of Daniel 2 and Genesis 41:15-40 raises insights as to the relevance for the management of any organization and governance. How does one explain that the House Rules, though in a democracy that gave license to various businesses, when it comes to pharma, children and the lack of understanding for what is generating the problems I would think requires distinct clarity. (And Leadership!). Additional reading references Genesis 41:15-40 about how Joseph would explain to Pharaoh the situation. If that were not enough, then another reading about Wisdom in the RBC’s Daily Bread, references Psalm 28 “If only We Could” when a situation might have evil within the hearts. Then there is a strong essay at Chabad.org regarding “The Challenge of Being an Isaac”, though the issues are not about things. Seemingly, to realize a life filled with child-like wonder and awe, the experiences that I/We read about are as much about stopped up “wells”. The challenge seemingly requires of each one and collectively of learning how to ask the questions, and the space to sort out the truths of what we are being told as it relates to each unqiue reality. The certainty that lives have been lost requires a response to a simple, “Why”?

  5. Listening to the Bazelon Law Center Awards tonight while recalling the memories of the times I would travel to the Center trying to realize change; change to access while creating the future city mirrored to the Alternatives Conference in Philadelphia by Justine Dart. Later, I would hear Marca Bristo from Chicago, then going over to Senator Durbin Office while a student at the School of Arts Institute in Chicago. Something seems to be missing from the language, the action by which the financial community figures out our economy is worthy to have our presence on the train. At what point, will children, as they travel through their life be able to access the appropriate resources to shape the space that affirms LIFE?

  6. I hate politics, but… biden and harris… “Come on, man! These kids need their medication! Medicated kids are just as smart and talented as non-medicated kids! Who are the parents to know better than a doctor! This is a social health issue, (Meanwhile, kamala harris locked up an entire generation of would-had-been-fathers-over weed.)”

    We’re back to politicians just following orders.

    I voted for Joe Rogan, he hates that job, He’s the one who should have it.

    • Part of the challenge in reading the threads, is keeping in mind at what time was the post made and then, how is the balance inherent to learning, either being a + or – if one wishes to think along this line. But then mayber there is also a third way, too. When we go to see the therapist or MD the next time, will we be able to realize even a more profound engagement in the discussions?

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