PHOENIX, ARIZ. – Four out of five children and adolescents under psychiatric treatment were receiving pharmacotherapy in a recent study, and slightly more than half of these received more than one psychiatric medication, Joyce C. West, Ph.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.
The use of concomitant pharmacotherapy was significantly higher among patients with co-occurring Axis I, II, or III disorders than among those without. But among children and adolescents with only a single identified disorder, about 40% were receiving two or more medications, Dr. West of the American Psychiatric Institute for Research and Education in Arlington, Va., told this newspaper.
“Given that we don't know about the efficacy or the potential safety and risks of concomitant pharmacotherapy in this population, the overall pattern highlights the need for more research,” she said.
Data for the study came from the American Psychiatric Association's Practice Research Network 1997 and 1999 studies of psychiatric patients and treatment.
These studies surveyed 754 psychiatrists who provided detailed data on a systematically selected national sample of 3,088 patients, 392 of whom were younger than 18 years.
Overall, 84% of these patients were receiving psychiatric medications, and 52% were receiving two or more psychiatric medications. Among all the child and adolescent patients, 10.2% were receiving three psychiatric medications, and 2.9% were receiving four or more psychiatric medications.
Antidepressants, used by 52% of the patients, were the most common of these medications, followed by stimulants (41%), antipsychotics (23%), antimanic agents (23%), and antianxiety medications (8%).
Patients who had been diagnosed with bipolar disorder, schizophrenia, and disruptive behavioral disorders were the most likely to be taking two or more psychiatric medications.
Rates of polypharmacy in patients with those diagnoses were 87%, 70%, and 61%, respectively. Polypharmacy was least common in patients with anxiety disorders, 44% of whom were receiving multiple medications.
Among the patients taking two or more psychiatric medications, an antidepressant together with a stimulant was the most common combination, seen in 21% of the patients.
About 11% of polypharmacy patients were receiving an antidepressant and an antipsychotic, and 7% were receiving an antidepressant and an antimanic agent, Dr. West said.