By Karla Harby
BOSTON, May 15
(Reuters Health) - Ritalin and Prozac, as well as various
combinations of similar stimulants and antidepressants, are being
prescribed together for an increasing number of children, according
to a new study presented here.
Among those children
taking Prozac, Zoloft, Luvox or Paxil--collectively known as
selective serotonin reuptake inhibitors (SSRIs) and prescribed for
depression, school phobias, bed wetting and eating disorders--in
1998, 30% were also taking Ritalin, dexedrine or related drugs,
presumably for attention-deficit disorder.
When the researchers
considered those children on Ritalin or similar drugs, they found
that 8% were also taking an SSRI.
"I think the safety
of these medications--in the young child especially--is not known,
and when you take them in combination it's a whole new level of
safety concern," noted Dr. Jerry Rushton of the University of
Michigan in Ann Arbor. "It's something that needs to be studied
These findings are
in addition to the overall trends showing a steep increase in the
number of children taking either drug type from 1990 through 1998,
Rushton pointed out. By 1998, 10% of children aged 6 to 14 years
were on Ritalin or stimulants, as were 1% of preschoolers aged 1 to
5 years. For SSRIs like Prozac, 2% of school-age children and 0.1%
of preschoolers had prescriptions for the drugs.
These drugs are
relatively new, and some increase in use over time would be
expected, but the dual prescriptions are surprising, Rushton added.
Rushton also found
that by 1998, just as many girls as boys were taking SSRIs. When
these drugs were first introduced, girls were given antidepressant
prescriptions twice as often as boys. The gender gap for Ritalin
likewise has narrowed, with three times as many boys as girls on the
drug in 1998, compared with the 10 to 1 ratio of the 1980s.
The reasons for
these findings are unknown. "The trends could be due to an increase
in recognition and diagnosis, and that's maybe a very positive
thing--we're treating children who were missed in the past," Rushton
But he said the
other hypothesis is that the trends show over-diagnosis, the idea
that "if the child is not doing so well, then if one drug didn't
work, maybe we should try two or three."
Rushton based his
study on North Carolina Medicaid data for prescription claims. He
presented his findings at the combined annual meeting of the
Pediatric Academic Societies and the American Academy of
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