Attention deficit disorder (ADD ADHD) usually requires only one ADHD treatment to bring symptoms under control.
But at least half of all ADHD children and adults also suffer from anxiety, depression, bipolar disorder, obsessive-compulsive disorder, anger control issues, or another comorbid psychological condition.
In such cases, multiple medications may be required.
As an ADHD child psychiatrist, several of my patients take more than one medication. David, a nine-year-old with a history of depression, racing thoughts, and a volatile temper, takes three: Concerta for ADHD and a combination of the mood stabilizer lithium and the antidepressant Wellbutrin for bipolar disorder. Rachel, age 11, takes Adderall for ADHD, along with Prozac for anxiety and obsessive-compulsive disorder.
Both children are doing well. David is less depressed and angry. He says his mind is “calm, like it used to be.” Rachel is no longer troubled by obsessive worries and repetitive behaviors.
As you might imagine, David’s and Rachel’s parents are pleased by the changes they see in their children, but they worry that they are “overmedicated.” I can tell by the questions they ask: Is it a good idea to give a child more than one psychiatric drug? What about side effects—and dangerous interactions?
Reasons Not to Worry
Let me offer some reassurance. If an individual has more than one kind of problem, it makes sense that he or she might need more than one medication. Would it seem inappropriate to give your child one drug for asthma and another for a skin infection? What if you needed one pill for heartburn, one for headaches, and another for diabetes? When it comes to physical ailments, doctors have a long history of prescribing multiple medications—and patients have come to accept the practice.
Until recently, this wasn’t true for psychological disorders. Doctors were unlikely to prescribe multiple medications because there wasn’t enough information about the biochemical basis for each disorder—and available medications weren’t specific enough in their action to work safely and effectively in combination. But over the past 20 or so years, scientists have gained a fuller understanding of neurotransmitters’ roles in brain function—and this has led to the development of new drugs that address specific deficiencies.
Minimizing the Risks
All medications pose risks, of course. But with few exceptions, the meds commonly used to treat ADHD can be used safely in conjunction with over-the-counter medications, as well as with the prescription drugs used for anxiety, depression, bipolar disorder, obsessive-compulsive disorder, anger control issues, and tic disorders. One exception: The antidepressant Wellbutrin can significantly amplify the effect of tricyclic antidepressants, like imipramine, desipramine, and nortriptyline. Consequently, Wellbutrin generally should not be prescribed in combination with tricyclics.
As a general rule, you should query your doctor any time a medication is prescribed (see "What to Ask Your ADHD Doctor," top sidebar). Most pediatricians and other primary-care doctors are capable of treating “uncomplicated” ADHD. But if your child has one or more comorbid conditions, in addition to ADHD, consult a child and adolescent psychiatrist. If your doctor is unable to offer a referral, go to aacap.org, the website of the American Academy of Child & Adolescent Psychiatry.
The Need for Tests
Some ADHD medications do call for periodic medical tests. For instance, children taking a nonstimulant should generally undergo liver function testing at least once a year. And since tricyclics sometimes affect heart rhythm, it’s probably a good idea to have an electrocardiogram before going on medication, and again after the therapeutic dose has been established.
But such tests are appropriate, whether or not a child takes any additional psychiatric medications. That is, taking an additional drug does not make it more likely that your child will experience the sorts of problems these tests are intended to detect.
This article comes from the October/November issue of ADDitude.