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Melatonin: prescribing practice in child and adolescent mental health service
- Sumudu H Chandraratne, Birgit Berg (8 January 2007)
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Sumudu H Chandraratne South West London & St Georges NHS Trust, Birgit Berg
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sumuduhc{at}hotmail.com Sumudu H Chandraratne, et al.
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A recent article published in the Psychiatric Bulletin provided a succinct overview of evidence for use of melatonin in the treatment of insomnia in children and adolescents (Psychiatric Bulletin, Jun 2004; 28: 222 – 224). Melatonin is an unlicensed drug in the UK although in the USA and some Scandinavian countries it is available over the counter and used as a dietary supplement. It is freely available over the Internet. A recent survey among community paediatricians revealed that melatonin is commonly given for children with autism and attention deficit hyperactivity disorder (3). Since the prescriber is fully accountable for any problems that might result from prescribing an unlicensed drug we decided to audit melatonin prescribing in our service. The sample of children attended an outpatient Child & Adolescent Mental Health Service in Sutton, Surrey between 01.09.05-31.08.06. Audit standards based on local guidelines involved obtaining informed consent prior to initiation of treatment, monitoring clinical benefits and identifying side effects during follow-up sessions (2). Thirty-two case notes out of 44 children prescribed melatonin during this period were evaluated. Out of these 22 carers were contacted by telephone to gather further details. Children between the ages of 5-16 years were prescribed melatonin with an average age of 10 years. The majority (30 out of 32) had a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) and 27 were on stimulant medication. It is not clear whether the sleep problems were secondary to stimulant medication or whether it was a symptom of a primary disorder. Other diagnostic categories involved were autism, visual impairment and learning disability. The dose prescribed ranged between 2- 10mg and was within the recommended limit for this unlicensed drug (2- 20mg). Dose adjustments were made by 2mg. The most frequently prescribed dose was 6mg while 4.5mg remained the average dose prescribed. Although documentation of informed consent and side effects was far from ideal, telephone interviews indicated that a large proportion (82%) was aware of its unlicensed status. However only 68% of the carers had knowledge of side effects. Three out of the 22 carers interviewed said that they did not receive a patient information leaflet. Seventy-seven percent of carers interviewed noticed an improvement in sleep. Out of this 32% indicated improvements in the child’s behaviour. They were reported to be calmer with improvements in school behaviour and fewer problems in the playground. If clinical benefits were not forthcoming melatonin was stopped preventing children taking a treatment that could have potential side effects. Our practice has taken into consideration the recommendations of this audit. Since then neighbouring services have expressed interest in carrying out a similar exercise. We hope that these results will encourage other child mental health services to evaluate their melatonin prescribing. References: 1. Armour, D., Paton, C., (2004) Melatonin in the treatment of insomnia in children and adolescents. Psychiatric Bulletin, Jun 2004; 28: 222 – 224 2. Medicines Information Service, Pharmacy Department in Springfield Hospital Melatonin: information leaflets for prescribing clinicians, GPs and families approved by the South West London Mental Health Interface Prescribing Forum (2005). 3. Waldron, D.L., Bramble, D., Gringas, P., (2005) Melatonin: prescribing practises and adverse events. Archives of Diseases in Childhood 90:1206-1207 |
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