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Clinician's Digest II

The Antipsychotic Epidemic

By Jared DeFife

An alarming number of children and adolescents who walk into a psychiatrist’s office in the United States each year walk out with prescriptions for powerful antipsychotic drug medications. According to data from a large national survey published in the Archives of General Psychiatry, these drugs are prescribed by psychiatrists to a third of the children and adolescents they see.

More than other psychotropic medications, antipsychotics are associated with increased risk of significant cardiac and metabolic problems, such as hypertension, obesity, and diabetes. These long-term effects may represent acceptable risks when balanced against the devastating functional deficits of severe mental illnesses, such as schizophrenia and bipolar disorder, which the drugs were intended to treat. However, the study researchers, led by Mark Olfson of Columbia University, discovered that in nearly 90 percent of the cases, the drugs are being used “off label” to treat conditions for which they’ve never been approved.

Data suggest that the most common reasons the drugs are being prescribed is for disruptive behavior disorders like AD/HD and oppositional defiant disorder. Meanwhile, there’s minimal evidence to support the efficacy of using such powerful medications for these conditions. “They’re approved for schizophrenia and bipolar disorder and irritability with autism,” Olfson told Reuters. “None of them are approved for use with AD/HD.” To make matters worse, little is known about the drugs’ effect on development when used for years. “In light of known safety concerns and uncertainty over long-term risks and benefits, these trends may signal a need to reevaluate clinical practice patterns and strengthen efforts to educate physicians,” write the study authors.

How did the drugs get so popular, given that there are such high risk factors and such limited evidence of efficacy with child and adolescent behavioral disorders? One explanation may be that prescribers are overgeneralizing from the mood-stabilizing and sedative effects of these drugs in adults, and assuming that the effects will be the same for disruptive children and adolescents. Or it may be that prescribers feel pressured by overburdened parents to take strong immediate action and ignore the potential long-term risks. Another reason, suggests medical psychiatrist Richard Friedman of Weill Cornell Medical College in a piece for the New York Times, is that the drugs have been “trumpeted in aggressive direct-to-consumer advertising campaigns . . . [with] little in these alluring advertisements to indicate that these are not simple antidepressants but powerful antipsychotics.”

The FDA is starting to take steps toward increased monitoring and evaluation of the medications. However, well-informed parents, who understand the proven benefits of psychosocial interventions in treating aggressive and disruptive behaviors, still represent the best protection for children.

Resources

Antipsychotic: Archives of General Psychiatry, doi:10.1001/archgenpsychiatry.2012.647

bit.ly/Qj8Twa

http://nyti.ms/SjtHZG

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