New Guidelines Proposed for Preschoolers on Antidepressants

With the number of preschool-age children being prescribed stimulants, antidepressants and other psychiatric drugs on the rise, a group of researchers has suggested a standardized approach to treatment.

Child mental health professionals from Bradley Hasbro Children’s Research Center in Rhode Island and 11 other institutions have developed recommendations for specific disorders to help clinicians who are considering medications for children ages 3 to 6.

The guidelines are published in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

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“These guidelines emphasize the importance of a family-focused assessment by clinicians with experience working with young children, the use of psychotherapy as the first line treatment for young children with severe psychiatric disorders, and the value of careful monitoring of symptoms and side effects when treating young children,” said lead author Dr. Mary Margaret Gleason, of the Bradley Hasbro Children’s Research Center.

The use of psychiatric drugs by preschoolers has increased by more than 50 percent in girls and more than 60 percent in boys, according to recent studies. Attention-deficit disorder hyperactivity drug Ritalin is No. 1 prescribed psychiatric medication for preschoolers, followed by antidepressants Prozac and Zoloft.

The U.S. Food and Drug Administration requires all antidepressant medications to carry a label warning that their use may increase the risk of suicidal thoughts in children and teens. More than 15 million U.S. children and teens take antidepressants regularly.

“(The guidelines) are not intended to promote the use of medications; rather, we anticipate that application of these guidelines may actually reduce the number of preschoolers who are taking psychiatric drugs,” Gleason said.

The guidelines cover a number of psychiatric disorders including attention deficit and hyperactivity disorder, disruptive behavior disorders, major depressive disorder, bipolar disorder, anxiety disorders, posttraumatic stress disorder, obsessive-compulsive disorder, pervasive developmental disorders (such as autism), and primary sleep disorders.

The group encourages clinicians to conduct full assessments on children before, during and after medication is prescribed.