Psychotropic use increases

According to a study in the Journal of the American Medical Association (vol. 283, no. 8) prescriptions of mood-altering drugs in two to four year olds increased from the years 1991 to 1995. The study examined three psychotropic medication classes: stimulants, antidepressants and neuroleptics, and looked at pharmacy data in patients from two Medicaid programs and one HMO finding that "Sizeable increases in prevalence were noted between 1991 and 1995 across the three sites for clonidine, stimulants and antidepressants while neuroleptic use increased only slightly." The study concluded, however, that, because of the number of medications with off-label indications, community-based, multidimensional outcome studies would be called for.

In an accompanying editorial in the same issue, Joseph T. Coyle, M.D., a faculty member of the departments of psychiatry and neuroscience, Harvard Medical School, questioned the extensive use of mood-altering drugs at such a young age. "Given there is no empirical evidence to support psychotropic drug treatment in very young children and there are valid concerns that such treatment could have deleterious effects on the developing brain, the reasons for these troubling changes in practice need to be identified," he wrote.

Coyle also called for deeper studies concerning the way psychotropic drugs are prescribed, and the products' effects over time. "[I]t would seem prudent to carry out much more extensive studies to determine the long-term consequences of the use of psychotropic drugs at this early stage of childhood."

Concluded Coyle, "...it appears that behaviorally disturbed children are now increasingly subjected to quick and inexpensive pharmacologic fixes as opposed to informed, multimodal therapy associated with optimal outcomes. These disturbing prescription practices suggest a growing crisis in mental health services to children and demand more thorough investigation." PR