Would you allow your child to be prescribed a powerful antipsychotic medication? If your first inclination is to say yes, would you still agree if you knew the drug was not tested or approved for children?
Researchers from British Columbia published a paper last week in the Canadian Journal of Psychiatry on what they described as an "alarming and exponential rise" of prescribing antipsychotic drugs to children. From 1996 to 2011, overall use of these medications among youth increased by 280 per cent, while the use of second-generation antipsychotic medications increased by 1,710 per cent.
The three most common reasons for treatment were depression, a group of disorders that includes attention deficit, hyperactivity disorder, and neurotic disorders that include anxiety.
How can this be? Antipsychotic medications were designed and approved originally to treat schizophrenia and bipolar disorder in adults. Over time, a few of the drugs have been approved for major depressive disorders in adults, and autism spectrum disorders. Only one drug, aripiprazole or Abilify, has been approved for use by children - to treat schizophrenia in youth aged 15 to 17.
It's because the vast majority of these powerful drugs has not been tested and approved for children, the side-effects are not fully known, although we do know that youth have more adverse events than adults.
An article in the International Review of Psychiatry found that antipsychotic use in children was associated with increased risk of significant weight gain, high blood sugar and cholesterol levels, cardiovascular disease and premature cardiovascular mortality. A review in the Journal of Clinical Psychiatry associated these drugs with an inability to initiate movement, an inability to remain motionless, sedation, prolactin elevation that disrupts menstrual periods, and various metabolic effects including increased risk of Type 2 diabetes.
A review in Drug Safety confirmed the results of the first two studies but added as side effects osteoporosis, spontaneous flow of milk from the breast, and sexual dysfunction.
In the B.C. study, psychiatrists were the major prescribers of antipsychotic medications to children for off-label or unapproved use, followed closely by family physicians. Pediatri-cians were much less willing to prescribe these powerful drugs to children.
Although the growth rate of prescriptions was largest for youth aged 13 to 17 years, children aged six to 12 still saw an increase of 280 per cent over the study period. The authors concluded that children are put on a wide range of potent drugs for a wide range of disorders without approval from Health Canada, and warned that we should be aware that these drugs have "potentially dangerous side effects."
In fact, Health Canada is now reviewing 17 suspected deaths among those serious side effects.So are drugs the only option? As mentioned, the main reason for prescribing them are disorders such as depression and attention deficit hyperactivity disorder. A Cochrane Collaboration review showed that behavioural and cognitive behavioural therapy significantly reduced child conduct problems, improved youth mental health, improved positive parenting skills, and reduced negative or harsh parenting practices. The programs also were found to be cost effective.
Another Cochrane review found that training for parents of children with hyperactivity disorder significantly reduced child withdrawal, anxiety, parent stress and child stress.
In Saskatchewan, the Ministry of Health reports that 2,520 children were prescribed antipsychotic medications in 2012, up from 464 in 1996. The number of children prescribed second generation antipsychotic medications grew to 2,410 in 2012, from just 146 in 1996.
The number of prescriptions filled for these drugs increased to 18,409 from 989 during the same time period. No information is available from the administrative claims database about the conditions for which the drugs were prescribed.
The claims numbers are underestimates because the data do not include prescriptions dispensed in hospitals and excludes those with federal benefits, such as First Nations children living on reserve. This last point is important because a number of publications have found that children from lower income families and minority groups are more likely to be prescribed antipsychotic medications.
An unpublished study from the Saskatoon Health Region found that children with mental health problems who live in affluent neighbourhoods were almost exclusively dispensed antidepressant medications.
In comparison, children with mental health problems who live in low-income neighbourhoods were almost exclusively dispensed antipsychotic medications.
Source
Researchers from British Columbia published a paper last week in the Canadian Journal of Psychiatry on what they described as an "alarming and exponential rise" of prescribing antipsychotic drugs to children. From 1996 to 2011, overall use of these medications among youth increased by 280 per cent, while the use of second-generation antipsychotic medications increased by 1,710 per cent.
The three most common reasons for treatment were depression, a group of disorders that includes attention deficit, hyperactivity disorder, and neurotic disorders that include anxiety.
How can this be? Antipsychotic medications were designed and approved originally to treat schizophrenia and bipolar disorder in adults. Over time, a few of the drugs have been approved for major depressive disorders in adults, and autism spectrum disorders. Only one drug, aripiprazole or Abilify, has been approved for use by children - to treat schizophrenia in youth aged 15 to 17.
It's because the vast majority of these powerful drugs has not been tested and approved for children, the side-effects are not fully known, although we do know that youth have more adverse events than adults.
An article in the International Review of Psychiatry found that antipsychotic use in children was associated with increased risk of significant weight gain, high blood sugar and cholesterol levels, cardiovascular disease and premature cardiovascular mortality. A review in the Journal of Clinical Psychiatry associated these drugs with an inability to initiate movement, an inability to remain motionless, sedation, prolactin elevation that disrupts menstrual periods, and various metabolic effects including increased risk of Type 2 diabetes.
A review in Drug Safety confirmed the results of the first two studies but added as side effects osteoporosis, spontaneous flow of milk from the breast, and sexual dysfunction.
In the B.C. study, psychiatrists were the major prescribers of antipsychotic medications to children for off-label or unapproved use, followed closely by family physicians. Pediatri-cians were much less willing to prescribe these powerful drugs to children.
Although the growth rate of prescriptions was largest for youth aged 13 to 17 years, children aged six to 12 still saw an increase of 280 per cent over the study period. The authors concluded that children are put on a wide range of potent drugs for a wide range of disorders without approval from Health Canada, and warned that we should be aware that these drugs have "potentially dangerous side effects."
In fact, Health Canada is now reviewing 17 suspected deaths among those serious side effects.So are drugs the only option? As mentioned, the main reason for prescribing them are disorders such as depression and attention deficit hyperactivity disorder. A Cochrane Collaboration review showed that behavioural and cognitive behavioural therapy significantly reduced child conduct problems, improved youth mental health, improved positive parenting skills, and reduced negative or harsh parenting practices. The programs also were found to be cost effective.
Another Cochrane review found that training for parents of children with hyperactivity disorder significantly reduced child withdrawal, anxiety, parent stress and child stress.
In Saskatchewan, the Ministry of Health reports that 2,520 children were prescribed antipsychotic medications in 2012, up from 464 in 1996. The number of children prescribed second generation antipsychotic medications grew to 2,410 in 2012, from just 146 in 1996.
The number of prescriptions filled for these drugs increased to 18,409 from 989 during the same time period. No information is available from the administrative claims database about the conditions for which the drugs were prescribed.
The claims numbers are underestimates because the data do not include prescriptions dispensed in hospitals and excludes those with federal benefits, such as First Nations children living on reserve. This last point is important because a number of publications have found that children from lower income families and minority groups are more likely to be prescribed antipsychotic medications.
An unpublished study from the Saskatoon Health Region found that children with mental health problems who live in affluent neighbourhoods were almost exclusively dispensed antidepressant medications.
In comparison, children with mental health problems who live in low-income neighbourhoods were almost exclusively dispensed antipsychotic medications.
Source
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