medsParents can be understandably nervous when learning the potential side effects of a medication prescribed to their child, but those risks are often outweighed by the medication’s perceived benefit. Researchers at Seattle Children’s Hospital are studying psychiatric medications to make sure the medicines they prescribe do less harm than good.

Robert Hilt, MD, is a child psychiatrist at Seattle Children’s Hospital who has successfully treated many children with psychiatric medications. Hilt began his medical career as a pediatrician and was initially reluctant towards prescribing psychiatric medications until he observed children benefiting from their use. His concern about the frequency of side effects from such treatments inspired him to lead a new study to measure the frequency and severity of side effects in children and adolescents taking psychiatric medicines.

“Typically, data reported by the U.S. Food and Drug Administration on medication side effects is based on six to eight week studies using a single drug for a single problem,” Hilt said. “But kids often have multiple conditions and may use several medications for years. We wanted to know how many of those kids were having side effects.”

More medications can mean more side effects

Parents across the country, whose children were prescribed psychiatric medications, completed an online survey for Hilt’s study reporting potential drug effects including increased appetite, sedation, insomnia, stomachache or headache. Most participants – 84 percent – reported their children had some side effects. The number of effects, and overall severity of them, increased with the number of psychiatric medications the children were taking. 

“Specialists will likely not be surprised, but those who use these medications less often, like primary care physicians, may be less aware of the potential additive side effect consequences of prescribing multiple psychiatric medications,” Hilt said.

The study showed side effects were most common in medication combinations that included either selective serotonin reuptake inhibitors (77 percent more likely), used to treat depression, or antipsychotics (99 percent more likely), primarily used to treat schizophrenia and bipolar disorder.

“We don’t know if these kids are experiencing more side effects because their psychiatric conditions are more severe or because of the medications themselves,” Hilt said. “Either way, kids taking these medications should be monitored more carefully.”

In some cases, Hilt said children may begin taking a second medication to address side effects from the first medicine prescribed. For example, a child with Attention Deficit Hyperactivity Disorder (ADHD) may develop problems falling asleep as a side effect from their stimulant medication. Instead of adjusting the stimulant medication to minimize insomnia or switching therapies, the child’s provider might prescribe an additional sleeping medication.

“Clinicians should consider replacing an incompletely effective or side effect generating psychiatric medication first before adding new medications to reduce side effect burdens, and should periodically reconsider if a child’s medications are all still necessary or if some could be decreased or discontinued over time,” Hilt said.

Medications use could be related to treatment access

Parents in Hilt’s study who reported difficulties in accessing psychiatric care noticed 42 percent more side effects in their kids than those with no access difficulties.

“Local access to skilled psychotherapies may be lacking, and even when available these therapies often do not yield their benefits right away,” Hilt said. “This increases the pressure to look for medications to solve a problem that might not have been needed if there was better or earlier access to skilled care.”

Multiple medication use is becoming more common

While the 1,347 respondents to Hilt’s online survey represented a response rate of just 7.5 percent, the findings are significant because no other research has reported on the relationship between increased psychiatric medications taken together and increased side effects.

The research is especially relevant to the increasing number of children taking more than one psychiatric medication. The most recent reliable national data, from 2005 to 2007, reported there had been a gradual increase up to 20 percent of children on psychiatric medications taking two or more drugs. Of the participants in Hilt’s study, 40 percent were taking two or more, though that data does not necessarily reflect the current overall national rate.

Recommendations

While there are many research studies demonstrating psychiatric medications benefit children with ADHD, depression, anxiety, bipolar disorder, psychosis and other conditions, Hilt said medications are not perfect and require careful monitoring by parents and prescribers.

“A medication that is effective psychiatrically and causes no side effects for a particular child can be a challenge to find, so people sometimes gloss over or unnecessarily accept the problems they can cause,” Hilt said. “But we want to do our best to minimize any potential side effect harm. At Seattle Children’s, we work with parents and children to find the best overall treatment approach possible and minimize multiple medication use whenever possible.”

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