Abstract
To Our Readers:
You may have read a troubling article in The New York Times in September about the risks when multiple psychiatric medicines are prescribed without a clear diagnosis or coherent plan. It was a frightening example of how polypharmacy—prescribing multiple medications—can be misused when kids have confusing problems that don't respond easily to treatment. Clear diagnosis, evidence-based care, and diligent follow-up are needed to ensure the well-being of our kids.
This issue of the journal has a very relevant paper from Bilsky et al on pediatric psychotropic polypharmacy (PPP) trends in a large national sample. I will also take the opportunity to point you towards resources prepared by my organization, the Child Mind Institute, to help parents and caregivers navigate this difficult topic.
Bilsky et al use the National Health and Nutrition Examination Survey to build a large, unselected sample (n = 11,439) of youth aged 4–17 years. The authors find that 1.2% of respondents were using two or more psychotropic medications, slightly higher than the rate reported in other national surveys. Predictors of polypharmacy include age, male gender, low socioeconomic status. The “most robust” predictor, the authors write, was having seen a mental health professional in the past year.
Bilsky et al cite a number of limitations imposed by the data, including lack of insight into symptom severity in individuals treated with multiple medications. However, the high prevalence of this practice should cause prescribing clinicians to carefully consider their actions and the evidence supporting them. Of even more concern are the 20% of youth in this study who are taking multiple medications but have not seen a mental health professional in the last year.
The Times article acknowledges that these medications can be important for the care of sick children, but two extreme examples might lead parents to conclude that they should avoid medication entirely. And that attitude can have serious adverse consequences for children in need. That's why the Child Mind Institute has developed resources to help parents understand how and why medications are used in mental healthcare, and how to go about getting the best possible care for their children.
The Child Mind Institute doesn't accept support from the pharmaceutical industry, so families and professionals can know our recommendations and information are unbiased. We hope these resources are helpful to your patients or your colleagues:
It is always concerning and often heartbreaking when kids get improper mental health care. We must do better. There are so many young people who can benefit from thoughtful, evidence-based treatment.