Marked increase in anti-psychotic Rxs for young people, but why?

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A new study finds that between 1993 and 2009, antipsychotic drug prescriptions skyrocketed among U.S. children and adolescents.

Published in the Archives of General Psychiatry, the study analyzed data collected from nearly half a million doctor visits and found that, among kids, the number of antipsychotic prescriptions increased from 0.24 for every 100 patients between 1993 and 1998 to 1.83 for every 100 people by the conclusion of the study a more than seven-fold increase. A similar trend was seen among teenagers, with prescriptions shooting from 0.78 per 100 patients, to 3.76 nearly a five-fold increase.

Lead researcher Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University, suspects that much of this increase is due to psychiatrists prescribing antipsychotic drugs for disruptive behaviors, like ADHD, despite none being FDA-approved for treatment of this disorder in kids. Officially, antipsychotics are indicated for other disorders, including schizophrenia, bipolar disorder, and irritability associated with autism. Nevertheless, a whopping 90 percent of antipsychotic prescriptions were in fact written for such off-label use between 2005 and 2009.

While it is clear that prescription rates are increasing, it is not so obvious why. For instance, as Dr. Olfson points out, there are other options for treating disruptive behaviors, such as psychosocial interventions like parent management training. Though these courses of treatment are often more time-consuming and expensive, they have proven to be effective, whereas the efficacy of antipsychotics for such off-label purposes remains unclear.

Virtually all schizophrenia drugs, for instance, have multiple pharmacological effects, says ACSH's Dr. Josh Bloom. Because of this, they are sometimes effective as other treatments: as mood stabilizers, for sleep disorders, or as an adjunct to antidepressants to name a few. From this study, it s not clear whether we re seeing an absolute increase in the childhood use of psychotropic drugs, or simply a switch from other types of medications.

However, ACSH's Dr. Gilbert Ross stresses, It s important for parents to be fully engaged in their child s treatment plans: Ask questions and request information about alternative approaches to treatment.