Friday, November 24, 2006

NYT: Kids Taking Lots of Psych Meds...

...despite a lack of evidence that polypharmacy is a good idea.

"Last year in the United States, about 1.6 million children and teenagers — 280,000 of them under age 10 — were given at least two psychiatric drugs in combination, according to an analysis performed by Medco Health Solutions at the request of The New York Times. More than 500,000 were prescribed at least three psychiatric drugs. More than 160,000 got at least four medications together, the analysis found.

Many psychiatrists and parents believe that such drug combinations, often referred to as drug cocktails, help. But there is virtually no scientific evidence to justify this multiplication of pills, researchers say. A few studies have shown that a combination of two drugs can be helpful in adult patients, but the evidence in children is scant. And there is no evidence at all — “zero,” “zip,” “nil,” experts said — that combining three or more drugs is appropriate or even effective in children or adults."


"The use of two-medicine combinations in children is on much shakier ground. Even for single drugs, the effectiveness of some psychiatric medications in younger patients is questionable: most trials of antidepressants in depressed children, for instance, fail to show any beneficial effect. But hardly any studies have examined the safety or the effectiveness of medicine combinations in children. A 2003 review in The American Journal of Psychiatry found only six controlled trials of two-drug combinations. Four of the six failed to show any benefit; in a fifth, the improvement was offset by greater side effects.

No one has been able to show that the benefits of these combinations outweigh the risks in children,” said Dr. Daniel J. Safer, an associate professor of psychiatry at Johns Hopkins University and an author of the 2003 review. [To read a great article by Dr. Safer regarding the influence of drug companies on research outcomes, check this out.]

If the evidence for two-drug combinations is minimal, for three-drug combinations it is nonexistent, several top experts said.

“The data is zip,” Dr. Hyman said."

The article mentions a few cases, one of which is mentioned below...

"Fate Riske, 3, of Fond du Lac, Wis., takes two antipsychotics and a sleeping medicine to control what her mother, Elizabeth Klein-Riske, said were hours-long tantrums, a desire to watch the same movies repeatedly and an insistence on eating the meat, cheese and bread in her sandwiches separately.

On a recent visit, Fate played sweetly for four hours as her parents, who both have trouble walking, sat in front of a television. Sucking on a pacifier, Fate showed off her pink dress and matching shoes.

Mrs. Klein-Riske credited the drugs for Fate’s cherubic behavior during the visit. But a few weeks on a different antipsychotic led Fate to become aggressive, talk rapidly and “run around wild, totally out of control,” said Mrs. Klein-Riske, who receives government financial and child-care assistance because her daughter is considered mentally ill.

Fate’s weight ballooned in five months to 48 pounds from 30."

So a three year old is taking two antipsychotics? Sounds kind of like the kid is acting like a three year old to me! OK, her behavior probably is worse than the average kid, but there should be more behavioral interventions before digging into the polypharmacy chest, don't you think?

Later on,

"Antidepressants are commonly paired with stimulants, but antidepressant use has declined over the last year after the F.D.A. warning about suicide risk. In their place, physicians are prescribing combinations that include antipsychotic and anticonvulsant drugs, according to Medco. From 2001 to 2005, the use of antipsychotic drugs in children and teenagers grew 73 percent, Medco found. Among girls, antipsychotic use more than doubled."

Read the whole thing here.


Alone said...

Oh my God, this is why I hate the NY Times.

"Both her sons are short and underweight for their age — a common side effect of stimulants-" --gee, any other possible explanation? After 28 meds-- currently Depakote, Risperdal and Catapres-- any other possibilities for weight loss?

11 different psychiatrists-- and the NY Times can't understand why the current psychiatrist didn't want to be interviewed?

God knows I'm the first to yell about polypharmacy. But are you kidding me that Gary Sachs is now saying patients "properly diagnosed" (of course with bipolar) are doing better on fewer drugs? This guy practically _invented_ polypharmacy with antiepileptics.

And Dr. Daniel "the benefits do not outweigh the risks" Safer-- isn't he the guy who made his name complaining that blacks didn't get as many psych meds as whites? Change of heart?

I'm going back to physics, this is ridiculous. Now that the winds are decidedly anti-Pharma, all of these guys come out against the medications on which they built their careers-- but only now that it's safe.

Now these academics are against SSRIs (all generic) and Depakote (generic) but you can't find one against Lamictal (not generic.) funny how that happened. Moral high ground should never affect one's bottom line. Just like politics.


CL Psych said...

As is your custom, very interesting comment. I am not familiar with the backgrounds of everyone in the article, so if indeed some psychiatrists are talking in a two faced manner about medication, that is unfortunate, though I’d also say it’s not very surprising.

My familiarity was Daniel Safer’s work is greater than any of the other docs in the article, and, at least in the past few years, I’ve noticed that his research has found disparities between racial groups in terms of psych med prescriptions, but I don’t recall his mentioning that this means that groups receiving fewer meds (i.e., non-Whites) should receive more meds. His conclusions, at least the ones that I recall, were merely descriptive, not a call for mass drugging. Plus he’s also written some thoughtful pieces regarding the drug industry (one is linked in the original post) that I would certainly not take as drug-promoting. However, he may well have changed his views over time; I don’t know.

“Now that the winds are decidedly anti-Pharma, all of these guys come out against the medications on which they built their careers-- but only now that it's safe.

Now these academics are against SSRIs (all generic) and Depakote (generic) but you can't find one against Lamictal (not generic.) funny how that happened.”

Great point overall. I can’t necessarily point fingers at any particular individuals on this one, likely due to my own ignorance, but the point that the “key opinion leaders” tend to hail new expensive treatments over older, cheaper, and generally equally efficacious products is certainly a sign that the relationship between the industry and academics has become far too cozy.

Magpie said...

I'm not a doctor, or psychologist, but I found that article frightening - especially the bit about the three year old. To me, that sounded like a three year old, not a kid who needed three different psychiatric drugs. Glad to see that someone closer to the field thought the same.