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 In particular, it appears they’re being used to treat attention
deficit and hyperactivity disorder (ADHD) – a condition for which
the powerful drugs are not approved.
The percentage of teens using antipsychotics rose from 1.10 percent
in 2006 to 1.19 percent in 2010. Use among young adults ages 19 to
24 rose from 0.69 percent to 0.84 percent, the study found.
With roughly 74 million children under 18 in the U.S., these small
percentages add up to large numbers of medicated kids.
“Great caution should be exercised in the use of antipsychotics,
especially for young children,” said lead study author Dr. Mark
Olfson, a research psychiatrist at Columbia University in New York.
Olfson and colleagues analyzed prescription data from 2006, 2008,
and 2010 as well as records from 2009 combining pharmacy and medical
claims information.
The records covered prescriptions filled at approximately 60 percent
of all retail pharmacies in the U.S.
Overall in 2010, approximately 270,000 antipsychotic prescriptions
were dispensed to younger children, 2.14 million to older children,
2.80 million to adolescents, and 1.83 million to young adults, the
authors write.
Antipsychotic drugs include Abilify (aripiprazole), Risperdal (risperidone),
Seroquel (quetiapine), Zyprexa (olanzapine) and others.
For younger children, antipsychotic use declined from 2006 to 2010,
the researchers report in JAMA Psychiatry. Prescriptions fell from
0.14 percent to 0.11 percent for kids aged one to six, and from 0.85
percent to 0.80 percent for children aged seven to 12.
This is most likely due to increased efforts to curb antipsychotic
use among younger kids over concerns about side effects such as
weight gain, high cholesterol and uncertainty about the long-term
effects of the drugs on the developing nervous system, Olfson said
by email.
Among children 18 and under, the most common reason for
antipsychotics was ADHD, the study found. This diagnosis accounted
for about 53 percent of prescriptions for younger children, 60
percent for older kids, and 35 percent for teens.
“This is concerning because evidence of antipsychotics’ efficacy for
treating a number of behavioral health disorders is lacking,” said
Meredith Matone, a research scientist with PolicyLab at the
Children’s Hospital of Philadelphia.
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Antipsychotics are approved in the U.S. for treatment of psychotic
conditions including bipolar disorder and schizophrenia, as well as
for easing aggression among cognitively impaired youth, Matone, who
wasn’t involved in the study, said by email.
“Increasingly, many youth are receiving these medications to treat
behavior problems in the absence of a more severe psychiatric
illness,” she said.
Part of this may be due to who is prescribing the drugs, according
to an editorial by Dr. Christoph Correll, a psychiatry researcher at
the Zucker Hillside Hospital in Glen Oaks, New York and the North
Shore-Long Island Jewish Health System.
Out of roughly seven million antipsychotic prescriptions written for
children, adolescents and teens in 2010, only 29 to 39 percent came
from a child and adolescent psychiatrist, he noted in the editorial.
“I was most surprised by the fact that the majority of youth
receiving antipsychotics did not have a mental disorder diagnosis,”
Correll told Reuters Health by email.
The study also exposed a gender gap, with prescriptions for boys
outpacing girls during elementary, high school and college years.
“The peak use among adolescent boys, who are frequently diagnosed
with ADHD and are also treated with stimulants, strongly suggests
that antipsychotics are commonly used to treat impulsive aggression
and other behavioral symptoms,” Olfson said.
Before parents agree to start their child on antipsychotics to
manage aggressive behavior, they should ask about alternative
treatments such as anger management, counseling for parents on how
to respond to aggression, and other psychosocial options, he said.
“The main takeaway for clinicians and families is that for youth
without psychiatric symptoms, alternatives to antipsychotic
treatment should be tried whenever possible,” Correll said. “When
antipsychotics are used, the lowest risk agents should be used for
the shortest time possible.”
SOURCE: http://bit.ly/1CQ2Qc0 JAMA Psychiatry, online July 1, 2015.
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