The International Journal of Neuropsychopharmacology

Reviews

Polypharmacy with antidepressants in children and adolescents

Covadonga M. Díaz-Canejaa1, Ana Espliegoa1, Mara Parelladaa1, Celso Arangoa1 and Carmen Morenoa1 c1

a1 Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain

Abstract

The aim of this study was to review current epidemiological data on the use of antidepressants in co-prescription with other psychotropic drugs in children and adolescents, as well as available efficacy and safety information. A Medline search from inception until February 2012 was performed to identify epidemiological and clinical studies, reviews and reports containing potentially relevant information on polypharmacy with antidepressants in young people. There has been an increase in polypharmacy in children and adolescents involving antidepressants in recent years. Antidepressants have become one of the drug classes most frequently prescribed in combination and are commonly co-prescribed with stimulants and antipsychotics. Most information regarding efficacy and safety of polypharmacy patterns was provided by case series and open-label studies. Efficacy studies gave some support for the use of a combination of antidepressants and antipsychotics in the management of refractory obsessive–compulsive disorder and some residual symptoms in major depressive disorder. Even less empirical support was found for a combination of stimulants and antidepressants in co-morbid attention deficit hyperactivity disorder and mood or anxiety disorders. Adverse events were similar to those found with individual medication groups, with severe adverse events mostly reported by individual case reports. The use of polypharmacy with antidepressants has become a regular practice in clinical settings. Although there is still little efficacy and safety information, preliminary evidence points to the potential clinical usefulness of some polypharmacy patterns. Further research on patients with co-morbidities or more severe conditions is needed, in order to improve knowledge of this issue.

(Received March 07 2012)

(Reviewed May 07 2012)

(Revised August 08 2012)

(Accepted September 21 2012)

(Online publication November 29 2012)

Key words

  • Adolescent;
  • antidepressant;
  • child;
  • polypharmacy;
  • SSRI

Correspondence

c1 Address for correspondence: C. Moreno, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM., Instituto de Investigación Sanitaria Gregorio Marañón, C/ Ibiza 43, 28009 Madrid, Spain. Tel.: 0034 91426 5005 Fax: 0034 91426 5004 Email: cmoreno@hggm

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