Published: July 10, 2007 at 8:44 AM
Ped Med: Kid use of mind medicines rising
By LIDIA WASOWICZ
UPI Senior Science Writer
SAN FRANCISCO, July 10 (UPI) -- Research reveals a surge in the use of anti-psychotics and other mind-altering medicines in children and adolescents.
The pharmacy benefits manager Medco Health Solutions' forecast
through 2007 describes the psychiatric drug class -- topped by
medicines for attention-deficit/hyperactivity disorder -- as "the most
powerful driver of spending growth" for children under 20.
Another study, of pharmacy claims for 83,039 minors under 18,
found their use of atypical, or second-generation, anti-psychotics
leaped 138.4 percent and of atypical antidepressants 42.8 percent
between 1997 and 2000.
Overall, 62.3 percent of children and adolescents seeking
mental-health services were prescribed psychoactive pills for their
troubles. At the same time, the average price of the medicines went up
by 17.6 percent, to $7.90 per order, the investigators said.
Producing less severe side effects than their predecessors,
atypical anti-psychotics -- including clozapine (brand name Clozaril),
risperidone (Risperdal) and olanzapine (Zyprexa) -- have made dramatic
inroads into children's treatment plans since their introduction in the
In seven years, anti-psychotic prescribing for children 2 to
18 rose nearly five-fold, from 8.6 per 1,000 youngsters in 1995 to 39.4
per 1,000 by 2002, a review of healthcare service records showed.
During the period, children made 5.8 million visits to the
doctor during which an anti-psychotic was prescribed. Pediatricians,
family-medicine and emergency-department practitioners and other
non-mental-healthcare providers wrote nearly a third of the drug
More than half of the prescriptions were made out for mood
swings and other conditions for which the chemicals have undergone
little testing, the authors said. For example, they noted, "no evidence
from controlled studies supports the use of anti-psychotics for
behavioral conditions such as attention-deficit/hyperactivity
Similarly, researchers found the number of youngsters ages 2
to 18 using the drugs in ways not specified on the label, or "off
label," nearly doubled, from 23 to 45 per 10,000, between 1996 and
2001, according to information from TennCare, Tennessee's managed-care
program that serves 1.2 million state residents.
During that time, the percentage of young patients receiving
an anti-psychotic for a new use soared from 6.8 percent to 95.9
The drugs most often were prescribed off-label for attention,
conduct and mood disorders. Over the six-year period, their use shot up
by 116 percent among adolescents, 93 percent among primary-school
children and 61 percent among preschoolers, the researchers said.
For its part, the stimulant bubble flattened between 1997 and
2002 -- with use of the medicine hovering at just below 3 percent of
the under-19 population, or some 2 million tykes and teens -- before
starting to inflate again in 2003 and 2004.
"The number of children on medications to treat severe
behavioral conditions related to autism and conduct disorders increased
by more than 60 percent from 2000 to 2003, while spending on these
drugs rose 142 percent in the pediatric group," market analysts noted.
"Among children ages 5 through 9, utilization was up 85 percent, while spending in this category grew 174 percent."
The drugs' growth spurt occurred against a backdrop of reports
that in varying degrees connected the medicines with a wide range of
ill effects in some pediatric patients:
-- the now-largely-abandoned Desipramine and since-revamped clonidine/stimulant combination with sudden death;
-- antidepressants with suicidal thoughts and behaviors, mania,
persistent pulmonary hypertension (abnormal blood flow through and
infant's heart) and withdrawal symptoms, including high-pitched crying,
tremors and disturbed sleep, in nearly a third of babies of women who
had taken the medication during pregnancy;
-- stimulants with preliminary hints of chromosomal
abnormalities, cardiovascular problems, including sudden death, and
-- atypical anti-psychotics with heart problems, excessive
weight gain and metabolic abnormalities, including possible
exacerbation or increased risk of diabetes. The finding, based on a
review of 40 studies, led the authors to caution that "serious
consideration should be given before initiating treatment" and to call
for consistent patient monitoring and additional investigations.
Similar conclusions were reached in another analysis of
published research, this one pertaining to the common, sanctioned use
of anti-psychotics as a treatment for schizophrenia.
In exploring the hot-button issue of whether it is ethical to
withhold treatment from psychotic study participants to measure a
drug's effectiveness, John Bola of the University of Southern
California raised one of his own.
While acknowledging the profound benefits the drugs can offer
in some cases, he nevertheless wondered "whether we should rush to
treat early episodes (of schizophrenia) with anti-psychotics, often
before a clear diagnosis has become evident."
His review of six studies involving 623 participants from the
1950s to the present came to a conclusion many psychiatrists dismiss:
Some patients may not need to be medicated immediately to improve.
It is important to identify these patients to prevent
needless exposure to side effects, which affect nearly half of the
drugs' users, asserted Bola, assistant professor in the School of
"The studies included in my review had mostly first-episode
psychosis patients with onset in the late teens and early 20s," Bola
said. "But with the finding of no evident long-term benefit at that
age, the exploding off-label use of anti-psychotics for children ...
becomes of greater concern."
Although it established no proof of cause, a May 2006 USA
Today investigation of Food and Drug Administration information
collected from 2000 to 2004 turned up at least 45 deaths of children in
which an atypical anti-psychotic was listed as the "primary suspect."
None of the drugs is approved for children's use.
Nevertheless, many practitioners consider anti-psychotics like
Risperdal a safe bet for helping reduce impulsivity and aggression.
"It has been used in children off label for years and years,
and there is a good body of literary research on it, conducted not by
pharmaceutical companies but by independent scientists who got
government grants to study treatment effects," said Donna Palumbo, a
University of Rochester specialist in neurology and pediatrics.
Others are more leery.
"Since we know of severe side effects in some cases, but not
who will get the side effects, it might be best to first exhaust
non-medical treatments that do not have side effects (i.e.,
psychosocial interventions, including behavioral treatment, cognitive
treatment, parental training) unless the situation is particularly
severe," Bola said.
(Note: This column is based on dozens of reports, conferences
and more than 200 interviews with specialists in children's health
issues. Wasowicz is the author of the new book, "Suffer the Child: How
the Healthcare System Is Failing Our Future," published by Capital
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