Kids' Use of Psychiatric Meds Triple
However, few studies have been done to show how effective SSRIs are in treating children, say both Olfson and Epstein. SSRIs include Celexa, Paxil, Prozac, and Zoloft.
"There are probably fewer than 10 studies [of antidepressants], whereas with stimulants, there are hundreds and hundreds of studies," says Epstein. "That's concerning to me, that pediatricians or psychiatrists are prescribing them at really high rates without knowing if they work."
Also, SSRIs have only been FDA approved for treatment of children with obsessive-compulsive disorder. "None of the antidepressants have been FDA approved for treatment of childhood depression," Olfson points out. "There is some data to support their effectiveness, but how they do over the longer term awaits further study."
The high numbers of children taking more than one psychiatric medication are of even more concern to Epstein. "There are no studies showing that a combination works, or that it's safe or effective," he tells WebMD.
In his study, Olfson identified a handful of examples of children under age six who were taking psychiatric medications. "Although rare, it does exist," Olfson says.
"There has been no scientific evidence to date that there should be reason for concern," points out Epstein. "I haven't seen any data yet that brains of kids who took these drugs are any different than brains of kids who didn't take these drugs. But with the really young kids, it's an ethical thing -- these are young kids, this is the period of fastest time of brain growth."
Epstein's program is one of six sites in an NIH-funded study looking at stimulant use in preschool children. "It's really going to tell us whether it's safe and effective to use these drugs in preschoolers," he tells WebMD. Duke is also participating in a study looking at combinations of SSRIs and stimulants in kids who have ADHD and anxiety.