Soaring numbers of children are being prescribed
anti-psychotic drugs — in many cases, for attention
deficit disorder or other behavioral problems for which
these medications have not been proven to work, a study
found.
The annual number of children prescribed anti-psychotic
drugs jumped fivefold between 1995 and 2002, to an estimated
2.5 million, the study said. That is an increase from
8.6 out of every 1,000 children in the mid-1990s to nearly
40 out of 1,000.
But more than half of the prescriptions were for attention
deficit and other non-psychotic conditions, the researchers
said.
The findings are worrisome "because it looks like these
medications are being used for large numbers of children
in a setting where we don't know if they work," said lead
author Dr. William Cooper, a pediatrician at Vanderbilt
Children's Hospital.
The increasing use of anti-psychotics since the mid-1990s
corresponds with the introduction of costly and heavily
marketed medications such as Zyprexa and Risperdal. The
packaging information for both says their safety and effectiveness
in children have not been established.
Anti-psychotics are intended for use against schizophrenia
and other psychotic illnesses.
However, attention deficit disorder is sometimes accompanied
by temper outbursts and other disruptive behavior. As
a result, some doctors prescribe anti-psychotics to these
children to calm them down — a strategy some doctors
and parents say works.
The drugs, which typically cost several dollars per pill,
are considered safer than older anti-psychotics —
at least in adults — but they still can have serious
side effects, including weight gain, elevated cholesterol
and diabetes.
Anecdotal evidence suggests similar side effects occur
in children, but large-scale studies of youngsters are
needed, Cooper said.
The researchers analyzed data on youngsters age 13 on
average who were involved in annual national health surveys.
The surveys involved prescriptions given during 119,752
doctor visits. The researchers used that data to come
up with national estimates.
Cooper said some of the increases might reflect repeat
prescriptions given to the same child, but he said that
is unlikely and noted that his findings echo results from
smaller studies.
The study appears in the March-April edition of the journal
Ambulatory Pediatrics.
Heavy marketing by drug companies probably contributed
to the increase in the use of anti-psychotic drugs among
children, said Dr. Daniel Safer, a psychiatrist affiliated
with Johns Hopkins University, who called the potential
side effects a concern.
Safer said a few of his child patients with behavior
problems are on the drugs after they were prescribed by
other doctors. Safer said he has let these children continue
on the drugs, but at low doses, and he also does periodic
tests for high cholesterol or warning signs of diabetes.
Dr. David Fassler, a University of Vermont psychiatry
professor, said more research is needed before anti-psychotics
should be considered standard treatment for attention
deficit disorders in children.
"Given the frequency with which these medications are
being used, there's no question that we need additional
studies on both safety and efficacy in pediatric populations,"
Fassler said.
