Experts say medical professionals should use caution when prescribing drugs for children’s mental health issues.
New research shows that antipsychotic medications can lead to serious side effects or even death for some children.
The recent study was and underscores past concerns members of the medical community have had about this class of drug that’s used to treat mental health conditions.
The observational study looked at the data of almost 248,000 children and young adults in Tennessee from the age of 5 to 24 who were enrolled in Medicaid between 1999 and 2014.
The patient data focused on people who weren’t diagnosed with some kind of psychosis, a symptom of a mental illness such as schizophrenia that can produce effects such as hallucinations.
The young people given a higher dose had a 3.5 times higher risk of unexpected death than the control group.
Those given the high dose were also 4.29 times more likely to experience metabolic and cardiovascular-related deaths than the control group.
“Antipsychotics are fairly dangerous drugs,” said Wayne A. Ray, PhD, lead author and a professor of health policy at Vanderbilt University School of Medicine in Tennessee.
“One of the questions heading into this was, ‘Given how infrequent unexpected death is in otherwise healthy children, would there be enough deaths to see the impact of antipsychotics?’ In fact, there were. The findings suggest that the concern over deaths related to antipsychotics in younger populations have an important public health impact.”
Ray stressed that these findings reinforce what many child psychiatrists have suggested in the past: medical providers should adhere to a conservative use of powerful antipsychotic medications for young patients.
“The findings suggest that the medical world consider other alternatives for treatment, that children and young adults with these illnesses would also respond to treatments other than these medications,” Ray told Healthline.
“All young patients should go through a pre-treatment evaluation, in particular, looking at if they have cardiovascular risks to see if a child or a young adult is at risk for arrhythmias. I advocate for a more cautious use of these drugs, and of course, there needs to be post-treatment monitoring for adverse effects.”
Robert L. Hendren, DO, a professor of psychiatry at the University of California San Francisco (UCSF) department of psychiatry and the Langley Porter Psychiatric Institute, told Healthline that it’s necessary that people on antipsychotic drugs be carefully monitored for a range of adverse side effects.
He said that significant weight gain and the presence of higher cholesterol and triglycerides are things to look out for as well as diabetes and movement disorders.
What about prescribing antipsychotics to young children under the age of 10?
“These medications can be very helpful to some children and adolescents and their families, but other interventions — with less potential serious side effects — should be tried first,” Hendren stressed.
“The behavioral symptoms of some children may reach this point at a young age — I do not go below 5 years, but know of cases where others felt this was the only viable alternative for even younger children. Usually the age is a bit older when children get big enough to do significant harm to themselves and others.”
Joseph Austerman, DO, a child psychiatrist at Cleveland Clinic Children’s Hospital, echoed these concerns.
He said it’s important to note that antipsychotic medications are largely prescribed as off-label treatment for illnesses in children.
“It is unclear the efficacy justifies the increased risk associated with their use,” he told Healthline.
He noted that the standard procedure for doctors is to treat mental illnesses with behavioral interventions and to use other first-line treatments before considering antipsychotics.
Despite his cautions, Austerman said that antipsychotics can be effective when standard treatments fail.
He added that this can justify the use of other medications down the line.
Hendren agreed, stressing that these can be an effective last resort for young patients.
“Antipsychotics can help with significant irritability, impulsivity, aggression, difficulty thinking clearly, significant anxiety, and psychotic thinking,” he said.
“At times families are very disrupted by these symptoms, have tried behavioral interventions and other medications, and find the effects of antipsychotics to be ‘life savers’ figuratively and literally for themselves and their children.”
For parents of children who need treatment for a mental illness, headlines generated around studies like this can be worrying.
Hendren said he can’t stress enough that these kinds of drugs must be prescribed and monitored by skilled doctors and “knowledgeable caretakers” to minimize problems that could arise.
He said that the data presented by this new study comes with some caveats.
For starters, could these young people in this specific population also have other risk factors for early death? These could be things such as out-of-home placement, inadequate monitoring, or other environmental factors tied to their homes, schools, or communities.
Regardless, he says the findings from studies like this one are significant.
“It still makes very important points for all families — use after other options have been given a good try and monitor carefully and thoughtfully. But when needed and in the right hands, the benefits outweigh the risks,” he said.
Austerman said that families and caregivers at home need to educate themselves about the risks as well and to be in close contact with their doctors and children’s medical teams to know what to look out for if something starts to go wrong.
“The patient must be informed of the need for close monitoring and the potential risks,” he said.
Moving forward, Ray said he would like to work with larger populations of people to see if the same patterns will emerge.
He reiterated that medical practitioners consider alternatives before prescribing antipsychotics, carry out careful pre-treatment, and closely carry out post-treatment monitoring.
“Essentially, the message of these findings is that this isn’t just some ‘theoretical problem,'” he said. “Concrete steps have to be taken to improve the safety of children and young people on antipsychotics.”
A new study published in JAMA Psychiatry looked at the data of nearly 248,000 children and young adults enrolled in Medicaid in Tennessee over the course of 15 years.
It found that some young people who are prescribed antipsychotic medications to treat mental illnesses had a higher chance of unexpected, early death than those who were given a treatment such as a mood stabilizer.
The findings point to doctors’ concerns that these drugs should be a last resort for young people and when they are prescribed, patients should be closely and carefully monitored.
These young people also didn’t have any previous risks for unexpected death, such as an unintentional drug overdose.