Published: July 10, 2007 at 8:44 AM
Ped Med: Kid use of mind medicines rising
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 1990s.

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 orders.

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 disorder."

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 percent.

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 hallucinations;

-- 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 Social Work.

"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 Books.)


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