Human Brain & Mind

No Antipsychotic Drugs for Children

There has been a sharp rise over the last decade in the prescription of psychiatric drugs for children, including antipsychotics, stimulants like Ritalin and antidepressants. The explosion in the use of drugs can be traced in part to the growing number of children and adolescents whose problems are given psychiatric labels once reserved for adults. Researchers, who analyzed data from a national survey of doctors' office visits, found that antipsychotic medications were prescribed to 1,438 per 100,000 children and adolescents in 2002, up from 275 per 100,000 in the two-year period from 1993 to 1995.

Pathak et al and colleagues found increases in the number of children younger than 18 years in Virginia, USA newly treated with an antipsychotic drug; the rate doubled between 2001 and 2005. There sample sample included 11,700 children. They also found that among new users, 41.3% had no diagnosis for which treatment was supported by a published study. The highest level of non–evidence-based use was with aripiprazole at 77.1%. Pam Harrison. Medscape Internal Medicine News. Unsupported Antipsychotic Use in Children Widespread. Accessed online Feb 2010. Also see Psychiatr Serv. February 2010.

First-time, antipsychotic use in children and adolescents is associated with rapid and significant weight gain as well as hyperlipidemia, and insulin resistance. A study of 272 pediatric patients showed that after a median of 10.8 weeks of treatment with antipsychotic medications, subjects gained an average of 18.7 pounds with olanzapine, 13.4 pounds with quetiapine, 11.7 pounds with risperidone, and 9.7 pounds with aripiprazole. A total of 10% to 36% of study participants transitioned to overweight or obese status within 11 weeks. JAMA. 2009;302:1765–1773

In the USA, Harris stated: “As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty. How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved. Drug makers generally spend twice as much to market drugs as they do to research them. ” (New York Times June 2007)

Antipsychotic drugs are the most potent brain altering chemicals; 90% of the antipsychotics prescribed to children were: clozapine, risperidone, olanzapine, and quetiapine. None of these drugs are approved for treating adolescents or children.

Harris pointed to yet another warning from a panel of federal drug experts convened by the FDA in the US (2008) that antipsychotic medicines are being used far too often in children with substantial risks. More than 389,000 children and teenagers were treated in 2007 with Risperdal, one of five popular medicines known as atypical antipsychotics; 240,000 were 12 or younger. The drug was often prescribed to treat attention deficit disorders, an indication not approved Involving risks which are “too profound to justify its use in treating such disorders." The same concerns concerns applied to the other drugs in its class, including Zyprexa, Seroquel, Abilify and Geodon.

The findings on the rising are likely to inflame a continuing debate about the risks of using psychiatric medication in children. In recent years, antidepressants have been linked to an increase in suicidal thinking or behavior in some minors, and reports have suggested that stimulant drugs like Ritalin may exacerbate underlying heart problems.

Antipsychotic drugs also carry risks: rapid weight gain and blood lipid changes that increase the risk of diabetes. None of the most commonly prescribed antipsychotics is approved for use in children, only a handful of small studies have been done in children and adolescents.

Reuters Health Information & Carey B. NYT June 6 2006. Reference Arch Gen Psychiatry 2006;63:679-685 Gardiner Harris. Use of Antipsychotics in Children Is Criticized. NYT November 19, 2008.

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