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Antipsychotics & Children: What are we doing?

Mental Illnesses in Children

“Tommy’s having such a tough time. God, I want to help him, but they want to put him on Abilify. I can’t let that happen.”

Last week I ran a need-to-know series on the atypical antipsychotics. In Part Two I expressed my alarm over the cavalier manner  in which they’re being prescribed for children and teens.

Here’s a link to the first in the series.

In follow-up, I’d like to share a bit of research that underscores my concern(s).

The Problems & the Study

Children who are first-time users of antipsychotics experience significant cardiometabolic changes within weeks of treatment initiation.

These changes often lead to insulin resistance and increased adiposity (of or relating to fat). Early cardiovascular disease and death are often the result.

Enter the study, “Metabolic Effects of Antipsychotics in Children.” The work was conducted at the University of Miami (Florida, US) Miller School of Medicine, and funded by the National Institute of Mental Health.

Its mission was to characterize changes in adiposity and insulin sensitivity in children receiving their first course of antipsychotic treatment.

The study participants were 125 aggressive children aged 6-18 who’d never used antipsychotics. The were administered aripiprazole (Abilify), risperidone (Risperdal), or olanzapine (Zyprexa) for a 12-week treatment period.

By the way, there was another problem the study ended up addressing. When lead investigator, Dr. John W. Newcomer, MD, was chair of the Drug Utilization Review Board for Missouri Medicaid he noticed something unusual. It seems antipsychotic prescriptions for children were increasing, but schizophrenic diagnoses weren’t.

Care to know why prescriptions were on the rise? Because they were being used to treat disruptive behavior disorders.

The Findings

First of all, it turns out there was a significant improvement in behavior using all three meds. In fact, Newcomer and his team were stunned by the results.

Ah, but nothing’s that easy. As expected, the cost of the improved behavior to the children was dicey changes in insulin and increased body weight.

The biggest weight-gain culprit? Olanzapine (Zyprexa).

The Take Away

Dr. Newcomer believes if a child or adolescent is schizophrenic an antipsychotic is indicated. But prescribing antipsychotics for disruptive behavior disorders doesn’t cut it. Other options have to be explored.

Obviously, developing insulin sensitivity and adiposity are major reasons. So is the potential for extrapyramidal side effects down the road.

Think about it, folks. We’re prescribing antipsychotic medications to children to manage behavior issues – not psychosis. Have we become that take-the-easy-way-out focused? What is wrong with this picture?

Before we part company, I have to point-out and comment on something that kind of bugs me. The study reports Dr. Newcomer has financial relationships with Big Pharma players Britsol-Myers Squibb, Janssen, Pfizer, AztraZeneca, Biovail, H. Lundbeck, Obecure, Sepracor, Sunovion, Dainippon Sumitomo Pharma, and Vivus, Inc.

Perhaps not with this study, but doesn’t his objectivity come into question?

Just thinkin’…