Are children overmedicated? Talking to your pediatrician about deprescribing drugs for mental health

Children who need psychotropic drugs can get better and may not need to be on medication in the long term. How to talk to your pediatrician.

The number of medications prescribed for children for many behavioral and mental health conditions has increased over the years, prompting concerns about overmedication of children.

Norton Children’s Behavioral & Mental Health

Outpatient and inpatient mental health care for ages 2 to 21. 

If you have an emergency situation or crisis, call 911 or visit the closest emergency department.

Medication successfully can treat behavioral and emotional conditions such as depression, anxiety, attention-deficit/hyperactivity disorder (ADHD) and insomnia. These drugs, which affect the central nervous system, are also known as psychotropics.

By keeping kids out of the hospital, the drugs also allow these children to benefit from psychosocial therapies in a less restrictive setting.

Sometimes children are on multiple psychotropics, a phenomenon known as polypharmacy, which can raise the possibility of unintended side effects or unexpected reactions in children as their brains are still developing. 

“The bottom line is, we just don’t know what the long-term outcomes are of these medications,” said W. David Lohr, M.D., child and adolescent psychiatrist with Norton Children’s Behavioral & Mental Health, affiliated with the UofL School of Medicine, and a professor of child and adolescent psychiatry at the medical school. 

Since kids’ mental health can improve, their need for medication may change. Working with your child’s pediatrician, you can discuss deprescribing — an evaluation of each prescription your child is taking, why they’re taking it and the pros and cons of each medication. Your child can be part of the discussion as well. In Ohio, a clinical advisory panel put together this toolkit for families considering deprescribing.

In collaboration with the state of Kentucky, Norton Children’s Hospital and others, the University of Louisville School of Medicine operates Kentucky SafeMed, which encourages safe use of medication with a focus on deprescribing psychotropic medications. Kentucky SafeMed offers the following guidance for families concerned about overmedication of their children:

Discussing deprescribing with your pediatrician

Reasons to discuss deprescribing:

  • You feel your child is on too many medicines or has taken them for a long time
  • Your child is under 6 years old
  • Things have been better for a while. Maybe therapy has helped.
  • The medicines have not helped or have made your child feel worse
  • There is less stress in your child’s life now.
  • There is a change in your child’s health (pregnancy, drug abuse, illness).

Medicine review

Talk about each of your child’s medicines:

  • Who prescribed it? When? Why? 
  • What are the pros and cons?
  • How does it help? Is it causing side effects?

Making a decision

You, the provider and your child will decide if there are medicines to decrease or stop and what to stop first.

Follow up

  • You and your child’s provider will plan for gradually stopping the medicine, and you’ll learn how to watch for issues.
  • Your child should continue therapy for mood or behavior issues.
  • You’ll want to help keep your child active to help them stay healthier.

Examples of psychotropic medication

  • Antipsychotics: risperidone (Risperdal); aripiprazole (Abilify)
  • Mood stabilizers: divalproex (Depakote); lithium
  • Antidepressants/anxiety: fluoxetine (Prozac); sertraline (Zoloft)
  • Stimulants: methylphenidate (Ritalin); amphetamines (Adderall)
  • Alpha-agonists: clonidine (Catapres); guanfacine (Intuniv, Tenex)

“Psychotropic medications can be very effective to treat illnesses,” Dr. Lohr said. “They are useful to level what I call the ‘biologic playing field.’ That means they can control symptoms such as inattention or insomnia, treat established mental health disorders like depression or ADHD and can make psychosocial therapies more effective.”

Possible effects of overmedication of children

Common side effects of psychotropics can include weight gain, movement abnormalities and sedation. 

It’s suspected that overmedication of children can contribute to conditions such as metabolic syndrome or tardive dyskinesia — repetitive involuntary movements.“It’s important to realize that when you have children who are developing, their brains are growing, and they react differently to medications,” Dr. Lohr said. “You may see only a short term response to a medication and we don’t know what the long term consequences could be.”