US psychiatrists were prescribing fewer antidepressants for children even before recent regulatory warnings about their safety and efficacy but polypharmacy was becoming more prevalent (J Clin Psychiatry 2009; pii: ej08m04212).

     Analysing claims for the South Carolina Medicaid program, investigators found that in 1544 children diagnosed with major depression there was a decrease in the use of antidepressants between 2001 and 2005. However, the proportion of children prescribed at least two psychotropic drugs increased from 7.9 per cent in 1996 to 58 per cent in 2003, falling to 45 per cent in 2005. The nature of the polypharmacy regimens changed with time, from various antidepressants plus a psychostimulant in the 1990s to antipsychotics co-prescribed with an SSRI, a mood stabiliser or a psychostimulant.
    These changes reflect emerging evidence of efficacy of novel treatment strategies, the availability of new drugs and marketing activity, and the clinical need to minimise risk. Polypharmacy is now common among US children with some form of depression.