Psychotropic Medication: Common Issues From Our Clinical Practice

Abstract

Since the early 1990s prescriptions of psychotropic medications to the child and adolescent psychiatric population have continued to increase; a substantial majority of youth in psychiatric treatment receive medication. A recent review of changes in the medication prescribing practices of child psychiatrists revealed that, from 1989 to 1994, there was an increase in overall psychotropic medication treatment. Additionally, significant increases in multiple concurrent medication treatments or polypharmacy occurred. The use of antidepressant treatment, particularly the selective serotonin reuptake inhibitors (SSRIs) has seen very rapid increases. This trend has also been observed for stimulants and antipsychotics with similar findings reported in recent studies of primary care practitioners and pediatricians. A recent study evaluated current prescribing patterns of outpatient child and adolescent psychiatrists in 1– to 18–year–olds (n = 1292). In this report, 74% (956 of 1292) of all patients received psychotropic medication, and 50% of these patients (478 of 956) received two or more medications. The most commonly prescribed medications were stimulants, antidepressants, antipsychotics and anticonvulsants. Medications typically used to treat mood disorders became the predominant medication prescribed for both outpatients and inpatients by child psychiatrists in 1994, leading to a proportional decline in prescribed stimulant treatment. This increased prescription of drugs to treat mood disorders and the increased rate of polypharmacy among child psychiatrists mirrors adult psychiatric practice. In our clinical practice, which includes inpatients, outpatients and day treatment at a university hospital, we prescribe medication in the majority of our patients in conjunction with psychoeducation, nutritional counseling, individual and group therapy. We present some of the issues that have arisen with each category of psychotropic medication, as well as our efforts at preventing some and resolving others of these issues. We hope not only to share our approach to using a variety of psychotropic medications, but also to stimulate discussions in similar clinics as to how best to address patient’s needs with rational use of these compounds.