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Combined Pharmacotherapy
There has been an emerging trend in psychopharmacology over the last decade to combine medications to more specifically cover multiple diagnoses in a child with comorbid conditions (Wilens et al. 1995;
Jensen et al. 1999; Woolston 1999; Conner et al. 1997). The benefit of such a practice is that each specific diagnosis can be treated with the most effective medication, but the pitfalls include deleterious effects of medication
combinations, which are not predictable from knowledge of the individual medications or their additive effect (Woolston 1999). There is a lack of controlled research on individual medications, much less combined pharmacologic
effects, so it will take a while for research to document the benefits that an experienced clinician may discover in practice (Jensen et al. 1999).
In the fragile X field, we usually encounter comorbid diagnoses including ADHD, mood instability, and anxiety. As described here and in chapter 1, the use, therefore, of combined pharmacotherapy is common
in both males and females with FXS, as illustrated in the survey described below. Importantly, however, combining psychopharmacologic treatment with counseling and therapies, as described in chapters 9, 10, and 11, is essential for
an optimal treatment program.
We carried out a survey of the pharmacologic agents currently used by the children and adolescents with FXS seen in clinic between 1997 and 2000 (Amaria et al. 2001). There were 140 males and 37 females
with FXS seen during this time. A summary of their medication use is found in figures 8.4 and 8.5. Among the males, only 9% were not taking any medication, 26% were taking a single medication that was usually a stimulant, and the
rest were taking two or more medications. The most common combination was a stimulant, typically methylphenidate, combined with a SSRI, typically either fluoxetine (16%) or sertraline (18%) (Amaria et al. 2001). Risperidone was
used in 13% of males and was often combined with a stimulant and/or a SSRI. Females with FXS (fig. 8.5) were more frequently taking either no medication (19%) or a single medication (35%). The single medication was often a
stimulant or a SSRI agent. Anxiety is a frequent problem in females; 27% were treated with fluoxetine, and 16% were treated with sertraline. In general, such behavior problems as severe ADHD or aggression are less common in females
with FXS, and this is reflected in their medication usage (Amaria et al. 2001).
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This article is not intended to give medical advice for individual cases. Any change in medical treatment
should be done in consultation with appropriate medical personnel. This article is written for medical professionals. Some of the terms will be unfamiliar to those who are not trained in medical fields.
*This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited
by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002. It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in
the book which are not included as part of this website.
The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling
1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.
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Medical Follow-up Pharmacotherapy Future Prospects
Outline Medications Medical Conditions
References: A, B, C, D, EF, G, H, IJ, K, L, M, NOP, QR, S, T, UVWXYZ
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