August 1

Russian Roulette Medicine: More kids get multiple psychiatric drugs

Russian Roulette Medicine: More kids get multiple psychiatric drugs

Wed, 3 Aug 2005

Stop the madness!

Child psychiatrist, Joseph Penn, advises: “Parents shouldn’t passively accept whatever doctors recommend for children with behavior or psychiatric problems.”

“We just don’t have the efficacy or safety data to back up what is common clinical practice.”

US physicians’  dependence on drug manufacturers whose sales representatives “educate” them about what drugs to prescribe, is doing harm.

America’s children are being put at risk of suicide and cardiac arrest and diabetes –all to increase profits.

The drug industry’s influence on prescribing guidelines–such as TMAP (Texas Medication Algorithm Project)–has certainly met its goal of increasing profits.

The cost, however,  is borne by children who are daily being harmed by the recommended drugs in those guidelines.

The fact that psychotropic drugs are prescribed increasingly in combination–without any supporting evidence of either safety or benefit–is a demonstration of the medical establishment’s irresponsible conduct.  Where once we trusted doctors to safeguard our health, we must now gird ourselves with protections against bad medical advice by doctors on the take.

Noting the newly issued black box warnings about the link between the use of antidepressants in children and suicidal thoughts, Dr. Penn asks: “if there is so much concern over the effects of a single drug, how much riskier is it to prescribe multiple drugs?”

The public can no longer rely on any of the medical oversight agencies–FDA officials have, in some cases, knowingly approved hazardous drugs, and approved drug labels that misrepresent unproven benefits while concealing the hazardous effects of patented drugs.

When will the biomedical / pharmaceutical industrial establishment be held accountable?

Contact: Vera Hassner Sharav

More kids get multiple psychiatric drugs
By Marilyn Elias
August 1, 2005

U.S. children diagnosed with behavior and psychiatric problems increasingly receive more than one medication despite very little proof that many of the drugs are safe or effective for kids, suggests a research review out Monday.

“We don’t know how these drugs may interact with each other, and we don’t even have safety studies in children for many of the drugs on their own,” says child psychiatrist Joseph Penn of Brown University Medical School and Bradley Hospital in Providence

He and co-author Henrietta Leonard searched the Pub Med database, covering published scientific research, for all studies on children’s psychiatric “polypharmacy” use between 1994 and 2004. Their report is in the journal Psychiatry 2005.

They found only six studies. Updates over time showed soaring use of multiple medicines with kids.

For example, a survey of primary care doctors giving children stimulants, commonly prescribed for attention deficit/hyperactivity disorder (ADHD), found multiple psychiatric medicines prescribed in about 5% of office visits during 1993-94. That surged to 25% of visits in 1997-98. Another study on privately insured kids found that 3% given psychiatric drugs got more than one in 1987. It was up to 23% in 1996.

Ask the doctor    

Parents shouldn’t passively accept whatever doctors recommend for children with behavior or psychiatric problems, says child psychiatrist Joseph Penn. If medications are advised for kids, he says, parents should ask these questions:

  • Is the drug approved by the Food and Drug Administration, and for what conditions is it approved?
  • Is it approved for use by children?
  • What are the short- and long-term benefits and risks of the drug?
  • Are there any interactions this drug has with other medicines?
  • How long will my child need to be on the drug?
  • Are there any side effects I should be looking for to report back to the doctor?

Doctors are using more medications for several reasons, says Penn:

  • Drug companies are marketing their products more aggressively to consumers and doctors. “Many parents come in and want that ‘quick fix.’ “
  • One drug often causes side effects; since more medications than ever are available, kids get another drug to deal with these side effects. For example, stimulants may cause insomnia, which leads to prescribing sleeping pills.
  • Insurers often are more willing to pay for pills than for therapy.

“Doctors are doing this polypharmacy stuff all the time with kids,” says Penn, “but when you look for the research, there is none.”

A newer class of medicines called “atypical antipsychotics” are increasingly combined with other drugs, he says. They’re used for kids with bipolar disorder (manic-depression) or severe temper problems. These drugs ‹ Abilify, Seroquel and Risperdal ‹ are approved for adult psychosis, “and we just don’t know if they’re safe for kids,” Penn says.  

However, there is “lots of shared anecdotal experience between doctors saying it’s OK to use more than one drug with children and adolescents,” says Lawrence Diller, a Walnut Creek, Calif., behavioral pediatrician.

And “sometimes you have to have different treatments to stabilize a child,” adds Boris Birmaher, a University of Pittsburgh psychiatrist who specializes in childhood bipolar disorder. “We wish one medication would take away their symptoms, but it doesn’t always happen.”

Many kids with ADHD have other problems, such as depression, and they may need multiple medicines, he says.

There’s not much profit incentive for drug companies to do research on multiple psychiatric medicines with kids, so more studies are unlikely, Diller believes. “Every doctor weighs the degree of symptoms against possible side effects of drugs. But in the absence of science, we’re all guessers.”


Many Kids Getting Multiple Psychiatric Medications
But researchers say side effects, interactions largely unknown

TUESDAY, Aug. 2 (HealthDay News) — Pediatric polypharmacy — prescribing two or more drugs to treat psychiatric symptoms in children — is becoming more common in the United States.

The trend is raising worries about potential unknown side effects, according to a study in the August issue of Psychiatry 2005.

“This is a critical issue — it’s not uncommon to find a child on an antidepressant, a mood stabilizer and a sleep agent all at the same time, but there’s no research to see how these drugs interact with each other,” study co-author Dr. Joseph Penn, a child psychologist with the Bradley Hasbro Children’s Research Center (BHCRC) in Providence, R.I., and Brown Medical School, said in a prepared statement.

He and his colleagues analyzed articles written over a 10-year period about pediatric polypharmacy. The articles showed that this practice is increasing in the United States, even though there are few scientific studies that can be used to justify it.

The study found the most frequent combination included stimulants such as Ritalin, Dexedrine and Adderall — commonly used to treat attention-deficit/hyperactivity disorder — used along with other psychotropic medication.

Penn and his colleagues also wrote that the prevalence of off-label prescriptions is another factor that increases the risks of prescribing multiple drugs to treat psychiatric symptoms in children.

“For example, atypicals like risperidone are sometimes used to symptomatically treat psychosis or aggression in children, but most of these medications don’t have FDA approval for use on psychiatric symptoms in the pediatric age group,” study co-author Dr. Henrietta Leonard, a child psychiatrist at BHCRC and Brown, said in a prepared statement.

“We just don’t have the efficacy or safety data to back up what is common clinical practice,” Leonard said. “The FDA recently questioned whether there is a link between the use of antidepressants in children and suicidal thoughts — if there is so much concern over the effects of a single drug, how much riskier is it to prescribe multiple drugs?” Penn questioned.

“We need more systematic studies to establish the safety and efficacy of medications in the pediatric age group,” he said.

More information

The American Academy of Child and Adolescent Psychiatry has more about psychiatric medications for children and teens.
(SOURCE: Lifespan, news release, Aug. 1, 2005)

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