NYTimes |
Every time Matthias is kicked out of a school or day camp for defying
adults and clashing with other children, his mother, Joelle Kendle,
inches closer to a decision she dreads. With each morning of
arm-twisting and leg-flailing as she tries to get him dressed and out
the door for first grade, the temptation intensifies.
Ms.
Kendle is torn over whether to have Matthias, just 6 and already taking
the stimulant Adderall for attention deficit hyperactivity disorder, go
on a second and more potent medication: the antipsychotic Risperdal.
Her
dilemma is shared by a steadily rising number of American families who
are using multiple psychotropic drugs — stimulants, antipsychotics,
antidepressants and others — to temper their children’s troublesome
behavior, even though many doctors who mix such medications acknowledge
that little is known about the overall benefits and risks for children.
In
2012 about one in 54 youngsters ages 6 through 17 covered by private
insurance was taking at least two psychotropic medications — a rise of
44 percent in four years, according to Express Scripts, which processes prescriptions for 85 million Americans. Academic studies of children covered by Medicaid
have also found higher rates and growth. Combined, the data suggest
that about one million children are currently taking various
combinations of psychotropics.
Risks
of antipsychotics alone, for example, are known to include substantial
weight gain and diabetes. Stimulants can cause appetite suppression,
insomnia and, far more infrequently,
hallucinations. Some combinations of medication classes, like
antipsychotics and antidepressants, have shown improved benefits (for
psychotic depression) but also heightened risks (for heart rhythm
disturbances).
But
this knowledge has been derived substantially from studies in adults —
children are rarely studied because of concerns about safety and ethics —
leaving many experts worried that the use of multiple psychotropics in
youngsters has not been explored fully. There is also debate over
whether the United States Food and Drug Administration’s
database of patients’ adverse drug reactions reliably monitors the
hazards of psychotropic drug combinations, primarily because only a
small fraction of cases are ever reported. Some clinicians are left
somewhat queasy about relying mostly on anecdotal reports of benefit and
harm.
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