The use of potent antipsychotic drugs to treat
children and adolescents for problems like aggression
and mood swings increased more than fivefold from 1993
to 2002, researchers reported yesterday.
The researchers, who analyzed data from a national
survey of doctors' office visits, found that
antipsychotic medications were prescribed to 1,438 per
100,000 children and adolescents in 2002, up from 275
per 100,000 in the two-year period from 1993 to 1995.
The findings augment earlier studies that have
documented a sharp rise over the last decade in the
prescription of psychiatric drugs for children,
including antipsychotics, stimulants like Ritalin and
antidepressants, whose sales have slipped only recently.
But the new study is the most comprehensive to examine
the increase in prescriptions for antipsychotics.
The explosion in the use of drugs, some experts said,
can be traced in part to the growing number of children
and adolescents whose problems are given psychiatric
labels once reserved for adults and to doctors'
increasing comfort with a newer generation of drugs for
psychosis.
Shrinking access to long-term psychotherapy and
hospital care may also play a role, the experts said.
The findings, published yesterday in Archives of
General Psychiatry, are likely to inflame a continuing
debate about the risks of using psychiatric medication
in children. In recent years, antidepressants have been
linked to an increase in suicidal thinking or behavior
in some minors, and reports have suggested that
stimulant drugs like Ritalin may exacerbate underlying
heart problems.
Antipsychotic drugs also carry risks: Researchers
have found that many of the drugs can cause rapid weight
gain and blood lipid changes that increase the risk of
diabetes. None of the most commonly prescribed
antipsychotics is approved for use in children, although
doctors can prescribe any medication that has been
approved for use.
Experts said that little was known about the use of
antipsychotics in minors: only a handful of small
studies have been done in children and adolescents.
"We are using these medications and don't know how
they work, if they work, or at what cost," said Dr. John
March, a professor of child and adolescent psychiatry at
Duke University. "It amounts to a huge experiment
with the lives of American kids, and what it tells us is
that we've got to do something other than we're doing
now" to assess the drugs' overall impact.
But many child psychiatrists say that antipsychotic
medication is the best therapy available for children in
urgent need of help who do not respond well to other
treatments. Without them, they say, many unpredictable,
emotionally unstable children would end up
institutionalized.
Dr. Mark Olfson, a professor of clinical psychiatry
at
Columbia University and the lead author of the
study, financed in part by the National Institute of
Mental Health, said the popularity of antipsychotic
drugs might result in part from "the fact that
psychiatrists have few other pharmacological options in
certain patients."
The study, which looked at visits to pediatricians
and other doctors, found that psychiatrists were the
most likely to prescribe antipsychotic drugs.
In light of how little these drugs have been studied
in children, Dr. Olfson said, "to me the most striking
thing was that nearly one in five psychiatric visits for
young people included a prescription for
antipsychotics."
The Columbia investigators analyzed data from the
National Center for Health Statistics survey of office
visits, which focuses on doctors in private or group
practices. They calculated the number of visits in which
an antipsychotic drug was prescribed to people under the
age of 21 and collected information on patients' medical
histories. The total number of visits that resulted in
prescriptions for the drugs increased to 1,224,000 in
2002 from 201,000 1993 to 1995.
The researchers attributed some of the increase to
the availability of a new class of drugs for psychosis,
called atypical antipsychotics, that were introduced in
the early and mid-1990's.
The newer drugs, heavily marketed by their makers,
were attractive in part because they appeared less
likely than older types of antipsychotics to cause side
effects like tardive dyskinesia, a neurological movement
disorder similar to
Parkinson's disease.
From 2000 to 2002, the new study found, more than 90
percent of the prescriptions analyzed were for the newer
medications, and most of the patients were boys,
predominantly Caucasian children, who were significantly
more likely to see psychiatrists than other ethnic
groups.
Some experts also pointed to an increase in the
diagnosis of
bipolar disorder in children as a contributing
factor. In recent years, psychiatrists have begun to
diagnose the disorder in extremely agitated, often
aggressive children with mood swings — short surges of
grandiosity or irritation that alternate with periods of
despair. These symptoms in children are thought to be
related to the classic euphoria and depressions of adult
bipolar disorder.
At the same time, several of the atypical
antipsychotics, including Risperdal from Janssen and
Zyprexa from Eli Lilly, won approval for the treatment
of mania in adults.
