Antipsychotic Drugs

Antipsychotic medications — ones used to treat schizophrenia and bipolar disorder — are often given to children who simply have behavioral problems associated with their age, according to a study published today in American Medical Association’s journal Psychiatry.

A research team from Columbia University, Yale, and the National Institute of Mental Health examined more than 2.5 million antipsychotic drug prescriptions for children from 2006 to 2010.

During that time, researchers found that antipsychotic prescriptions increased for children and young adults ages 13 to 24 but not for children under the age of 12.

The study found the most antipsychotic use, especially among boys, was consistent with impulsive and aggressive behaviors, not psychotic symptoms.

The numbers “suggest that much of the antipsychotic treatment of children and younger adolescents targets age-limited behavioral problems,” the study states.

That bothers psychiatrists like Dr. Vilma Gabbay, chief of the pediatric mood and anxiety disorders program and associate professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City.

“The findings are alarming,” she said.

Antipsychotic Drugs

The study found antipsychotics were most commonly prescribed for attention deficit hyperactivity disorder (ADHD) in children under the age of 18. About 60 percent of children ages 7 to 12 years who received an antipsychotic were given it for ADHD.

About a third of young adults were given antipsychotic medications for depression.

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Medications Come with Harmful Side Effects

Side effects of some atypical antipsychotics, such as olanzapine (Zyprexa) and risperidone (Risperdal), include changes in metabolism that can include weight gain of up to 70 pounds. That can increase a child’s risk of diabetes and high cholesterol.

These side effects have been under clinical scrutiny for more than a decade.

But, researchers noted, after several years of increasing rates of antipsychotic treatment of children and adolescents in the United States, the rate of antipsychotic use among children decreased between 2008 and 2010.

“In view of evidence of widespread antipsychotic prescribing outside of U.S. Food and Drug Administration-labeled indications and concerns regarding the adverse metabolic effects of second-generation antipsychotics, this decline is a welcome development,” researchers wrote.

Dr. Theodore Henderson, Ph.D., a child psychiatrist in the Denver area who was not involved in the study, said the study’s findings are in line with the rates of those conditions in children and adolescents.

“Overall, it’s a good study because it looks at the rates,” he said. “If you look at the incidence of these disorders in children, they are on par.”

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Antipsychotic Medications for Nonpsychotic Conditions

Most commonly, as the study shows, antipsychotics are used to control aggressive behaviors in children with ADHD.

Some research has shown combining traditional stimulant therapy like methylphenidate (Ritalin) and antipsychotic medication can control violent outbursts in children with ADHD.

For other conditions, such as bipolar disorder and behavioral disorders, mood-stabilizing drugs are the first line of treatment, along with outpatient therapy and other methods.

Antipsychotic medications were developed to help conditions like schizophrenia, but as some atypical antipsychotics also have mood-stabilizing effects, they are used even when no psychotic symptoms are present.

“A lot of the doctors skip over mood stabilizers and go to atypicals first,” Henderson said. “As a psychiatrist, that gives me concern.”

Antipsychotics are used to treat depression in what’s known as “treatment resistant” depression where typical antidepressants aren’t working. There is, however, little evidence to suggest antipsychotics benefit people with hard-to-treat depression and aren’t worth the potential side effects.

Doctors should look for other options at controlling minor aggression in children with ADHD or autism, including stimulant drugs, talk therapy, and parent training, because of the side effects of antipsychotic medication, Gabbay said.

“When we prescribe these medications, we are very careful to weigh the costs versus the benefits,” she said. “These [medications] are not Tylenol. [They are] very serious medication[s].”

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Not All Antipsychotics Are Made Equal

The first antipsychotic was developed in the 1950s. These “typical antipsychotics” block dopamine in the brain, which decreases excitability.

Atypical, or second-generation, antipsychotics block dopamine and affect serotonin, which can improve mood.

When atypical antipsychotics hit the market — namely with Zyprexa in 1999 — the drug industry pushed them harder because they claimed they were better than typical antipsychotics, Henderson said.

“But research shows atypicals aren’t any better because of side effects like weight gain and metabolic disturbances,” he said. 

The atypical antipsychotic aripiprazole (Abilify), however, is a “unique animal,” Henderson said, because it helps control behavior and has shown to be a cognitive enhancer, which can help a child academically. 

The antipsychotic drug market was greatly impacted when molindone (Moban) was discontinued from the U.S. market in 2010. 

“It used to be my favorite, and I’ve talked to colleagues and we agree it was the best,” Henderson said.