Prescribed by 94% of psychiatrists in Canadian study
Sharon Kirkey, CanWest News Service
Canadian children are being widely prescribed antipsychotic drugs for behaviour and mood problems, with a significant proportion of the powerful drugs going to children under the age of nine, new research shows.
Ninety-four per cent of 176 child psychiatrists in Canada surveyed are prescribing drugs known as atypical antipsychotics for a variety of disorders and symptoms, including anxiety, attention-deficit hyperactivity disorder and "poor frustration tolerance."
While most prescriptions were for children 13 and older, researchers found that a "surprising" number were for the very young: Twelve per cent of all prescriptions were for children aged eight or under, including three-year-olds.
None of the drugs has been officially approved for use in children. All are in a different class from Ritalin, a stimulant used to treat attention deficit disorder in children.
Risperidone (brand name Respirdal) was the most commonly prescribed atypical antipsychotic for children, followed by olanzapine (Zyprexa) and quetiapine (Seroquel).
Originally developed to treat schizophrenia, these kinds of antipsychotic drugs are increasingly being used to treat non-psychotic disorders in adults, children and teenagers.
"These medications are currently being used off-label without clear guidelines for indications, dosing and monitoring," researchers report in the most recent issue of the Canadian Journal of Psychiatry.
"There is an urgent need for more data regarding safety and monitoring of these medications in children."
In the United States, the number of visits to a doctor that ended with a patient under 20 being prescribed an antipsychotic soared six-fold between 1993 and 2002.
The new Canadian survey cannot answer just how many children or teenagers are on antipsychotics in this country. But it suggests that prescribing by child psychiatrists and pediatricians who specialize in developmental problems is "ubiquitous."
"Intuitively we all say, 'Geez, these are young kids to be on medicine.' Kids that age are put on drugs for asthma, and they're given antibiotics and different sorts of medication. I think we all get a bit concerned if it's something that affects the brain," says the study's lead author, Dr. Tamison Doey, head of the division of child and adolescent psychiatry for the City of Windsor and an adjunct professor at the University of Western Ontario.
Most of the specialists surveyed monitored their patients. But the types and frequency of tests performed varied widely.
"The concern is, will other doctors start to use these medicines and how can we guide them to do it appropriately," Dr. Doey said.
Atypical antipsychotics are considered a significant improvement over older antipsychotics that were used in both adults and children. For one thing, they do not cause the same neurological side effects, such as uncontrolled jerking and twisting.
But they can cause substantial weight gain.
Researchers at Johns Hopkins University have warned the drugs might trigger insulin resistance in children, increasing the risk of developing Type 2 diabetes and heart disease when they are older.
The drugs work by blocking dopamine, a brain chemical involved in aggression and impulsivity.
Dr. Doey said they can make the difference between having a child in school or not, "or a child having friends, or having terrible outbursts every time something doesn't go their way."
They are being used to treat depression, impulsivity and children who frustrate easily.
The kids we see will have major aggressive or disruptive episodes for even the slightest reasons," Dr. Doey said.
"So if they can't do something in school or someone tells them to turn off the television or you can't run in the corridor, you name it, they proceed to become very angry and aggressive and out of control."
Her team plans to follow children prescribed atypical antipsychotics over a year to look at the effects of the drugs over the longer term.