Antipsychotic drugs are prescribed during almost one in three of all visits kids and teens make to psychiatrists in the United States, according to a new study, up from about one in eleven during the 1990s.
Much of that increase, researchers say, is from doctors prescribing the drugs for disruptive behaviors, such as attention deficit/hyperactivity disorder (ADHD). There are, however, no antipsychotics approved by the U.S. Food and Drug Administration to treat those disorders in kids.
"They're approved for schizophrenia and bipolar disorder and irritability with autism. None of them are approved for use with ADHD," said Dr. Mark Olfson, the study's lead author and a professor of clinical psychiatry at Columbia University in New York.
Olfson and his colleagues, who published their work Monday in the Archives of General Psychiatry, found that for kids and teens, roughly 90 percent of the antipsychotic prescriptions written during office visits between 2005 and 2009 were "off label," which means the drugs are being prescribed for something other than for what they're approved.
While the study cannot say whether the prescriptions were unnecessary, the effectiveness of antipsychotic drugs for disorders like ADHD is uncertain. The drugs, however, have been linked to weight gain and diabetes.
Last year, a large study of children, from the University of Massachusetts, found that kids who took antipsychotic drugs were four times more likely to develop diabetes than their peers who were not taking the medications. (See Reuters Health story of November 22, 2011: reut.rs/MtH5dB.)
In September, an FDA advisory board also raised concerns about the drugs and urged the agency to monitor weight gain and other metabolic diseases in children taking antipsychotics. (See Reuters story of September 22, 2011: reut.rs/MtHCwe.)
"For some of these kids, taking these can be setting themselves up for metabolic problems in the future," said Olfson.
Prescriptions and alternatives
For their study, Olfson and his colleagues used information on almost half a million doctors' visits in the U.S. between 1993 and 2009.
Overall, antipsychotic prescriptions increased across all age groups - including adults. For kids and teens, however, the increase was more rapid.
The number of kids getting antipsychotic prescriptions increased from 0.24 for every 100 people between 1993 and 1998, to 1.83 for every 100 people between 2005 and 2009.
For teens, that number increased from 0.78 for every 100 people in the 1990s to 3.76 in the 2000s.
"There is very little question as to whether these drugs are being prescribed in kids much more than they used to," said Olfson.
Those numbers, however, only represent the number of people going to doctors' offices - not clinics, community health centers or other medical centers.
Also, the researchers cannot say how long patients were on the drugs, or whether any of the prescriptions were from repeat visits by the same patient.
Overall, Olfson told Reuters Health that he hopes parents ask more questions about antipsychotics and whether there are any alternative treatments.
He said there are psychosocial interventions such as parent management training that have been shown to reduce aggressive and disruptive behaviors in kids, but added that those interventions are more expensive and take more time.
"Perhaps if they were more available, we wouldn't have as much use of these antipsychotic medications," Olfson said.