From Psychiatric News: August 4, 2006
Children and adolescents prescribed newer antipsychotic medications must be closely followed as the risk of significant acute and long-term adverse effects may be higher than in adults.
A series of recent reports documenting increases of between 200 percent and 300 percent in the prescribing of second-generation antipsychotics (SGAs) to children and adolescents since the mid-1990s has prompted experts to remind prescribers that a critical part of using the medications involves clinical monitoring and follow-up of the drugs' potentially serious acute and long-term adverse effects. "Prescribing of antipsychotic medications to children and adolescents is certainly a serious step for any clinician to undertake," noted Christoph Correll, M.D., director of the Adverse Events Assessment and Prevention Unit at Zucker Hillside Hospital/Long Island Jewish Medical Center and an assistant professor of psychiatry at Albert Einstein College of Medicine. "We really have to strike a balance between the efficacy of these medications and the severity of the conditions for which they are being prescribed, versus the potential for serious side effects."
There has been a substantial increase in the prescription of antipsychotic medications to young people in office-based practice," said Mark Olfson, M.D., M.P.H., a professor of clinical psychiatry at Columbia University College of Physicians and Surgeons. Olfson and his colleagues reported in the June Archives of General Psychiatry results of an analysis of data from the National Ambulatory Medical Care Surveys (NAMCS) from 1993 to 2002. In 1993, the estimated number of office-based visits by patients 20 years and younger that included antipsychotic prescriptions was approximately 201,000. By 2002, the number had risen to an estimated 1,224,000.
Overall, 92.3 percent of visits that included a prescription for an antipsychotic medication involved SGAs. The most common diagnoses associated with visits in which SGAs were prescribed were disruptive behavior disorders such as ADHD, oppositional defiant and conduct disorders (37.8 percent), mood disorders (31.8 percent), pervasive developmental disorders or mental retardation (17.3 percent), and psychotic disorders (14.2 percent). Another group, led by pediatrician William Cooper, M.D., at Vanderbilt University, also studied the NAMCS database along with data from the National Hospital Ambulatory Medical Care Survey, which includes information on visits to emergency departments and hospital outpatient clinics. . . . white males were more likely to be prescribed an antipsychotic, and the most frequently listed diagnosis was ADHD or conduct disorder (29 percent) followed by bipolar disorder or depression (23.5 percent). Cooper documented a nearly six-fold increase in antipsychotic prescriptions from prescribers in a specialty mental health setting (for example, mental health clinics as well as psychiatric offices) compared with a three-fold increase during visits to non-mental-health prescribers.
Rye Hospital Center warns:
What is critically important here, is that these drugs are prescribed based on the clinician's review of patients' behavioral symptoms, and rarely on the range of competing or interfering drugs they are taking or may have to take in the future as a result of their physical needs or periodic illnesses while on the new medication.
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The metabolic syndrome is but one serious problem occurring from the knee-jerk reaction to solve problems with pills. The chart above demonstrates the potential problems occurring with the new "Second-Generation" antipsychotic medications--even when they are used alone. When they are taken with other drugs--competing "inhibitors" or "inducers"--the negative effects can be expected to be even greater. (See also "Serotonin Syndrome.")
* Note: In the 1970s, Clozapine (Clozaril) was the first "atypical" or "Second Generation" anti-psychotic medication to be approved for clinical practice. During the 1990's, olanzapine (Zyprexa), risperidone (Risperdal), and quetiapine (Seroquel) were introduced, with ziprasidone (Geodon) and aripirazole (Abilify) in the early 2000s. Because there is a strong association between the date of FDA approval of these drugs and the reported adverse effects, as more information comes in from post-marketing surveillance, adverse affects of all "Second Generation" anti-psychotic medications are appearing increasingly to resemble each other.