On August 27, The New York Times ran an article by Matt Richtel titled “This Teen Was Prescribed 10 Psychiatric Drugs. She Is Not Alone.” It documents the practice of “polypharmacy”: prescribing multiple medications—most of which have not been tested either in children or in combination with one another—to manage young patients’ depression or anxiety.
That young patients are being prescribed potent cocktails of untested drugs is obviously wrong. The question is, how did we get to this point, and what can we do about it?
As summer rolls around, families may ask whether their children can have a “holiday” from their psychoactive medication, especially for attention-deficit hyperactivity disorder (ADHD). We asked Lawrence Amsel, MD, MPH, a REACH faculty member and associate professor of psychiatry at Columbia University, to lay out the pros and cons.
Newer treatments approved by the Food and Drug Administration (FDA) for pediatric patients with attention-deficit/hyperactivity disorder (ADHD) include two medications that address some of the common issues families have with standard stimulant treatments. Another development is use of devices to manage ADHD symptoms.
If you struggle with titrating psychiatric medications for your pediatric patients, you are not alone. Even for some alumni of the REACH program Patient-Centered Mental Health in Pediatric Primary Care, lack of comfort with psychiatric medications can hamper effective treatment.
What does it take to dose and cross-titrate effectively? We asked two REACH faculty members: Peter S. Jensen, MD, REACH founder, and Amy Kryder, MD, education lead of the statewide REACH program in Virginia.
“Going to college is exciting, but students need to know that this experience, though positive, may also be stressful,” said REACH faculty member Elena Man, MD. Dr. Man recommends resources and strategies that pediatric primary care clinicians can use to prepare patients for this significant transition to a new environment for learning, living, and friendships.
The new edition of Guidelines for Adolescent Depression in Primary Care (GLAD-PC) is now available on The REACH Institute website. This practical toolkit offers dozens of resources to help pediatric primary care providers diagnose and treat depression.
“We have kids who come in here on three, four different medications,” says Dr. Elizabeth Wallis, MD, “and we don’t know why. We don’t know what data were used to make those decisions.” Dr. Wallis, director of the Foster Care Support Clinic (FCSC) of the Medical University of South Carolina and a REACH faculty member, was expressing just one of the challenges of treating children and youth in the foster care system.
“For these straightforward cases, when you can identify uncomplicated ADHD in patients without co-occuring depression or anxiety – well, everyone in primary care should be able to do this.”
“Every pediatric and family practice resident should be required to take this course! I will take away a renewed appreciation for assessment tools, a new comfort with treatment plans, and an excitement for future partnerships”