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Antipsychotics may be excessively, unnecessarily prescribed to adolescents

Results from a population-level, retrospective, observational study suggest that much of the antipsychotic use among children in the United States targets limited impulsive and aggressive behaviors rather than psychotic symptoms.

“Clinical trials support the efficacy of several antipsychotics for child and adolescent bipolar mania, adolescent schizophrenia, and irritability associated with autism in adolescents and children as young as 5 (risperidone) and 6 (aripiprazole) years. Yet most office visits by children and adolescents that involve antipsychotic treatment do not include one of these clinical diagnoses,” study researcher Mark Olfson, MD, MPH, of Columbia University, and colleagues wrote. “Concerns have been raised regarding the risks of antipsychotic medications to the cardiovascular and metabolic health of young people.”

Mark Olfson

Researchers reviewed data from the IMS LifeLink LRx Longitudinal Prescription database for all antipsychotic prescriptions filled for patients aged 1 to 24 years in 2006 (n = 765,829), 2008 (n = 858,216) and 2010 (n = 851,874). Data from the 2009 IMS Medical Claims Database for service claims was also reviewed for a subset of these patients (n = 53, 896).

From 2006 to 2010, the percentage of young people using antipsychotics decreased from 0.14% to 0.11% among children aged 1 to 6 years and from 0.85% to 0.8% among children aged 7 to 12 years. The percentages increased among adolescents (1.1% to 1.19%) and young adults (0.69% to 0.84%).

Males were more likely to use antipsychotics than females in 2010, particularly during childhood and adolescence.

Of the young people who received antipsychotics in 2010, having a prescription from a psychiatrist was less common among children aged 1 to 6 years (57.9%) than other age groups, which ranged from 70.4% to 77.9%.

Approximately 30% of children aged 1 to 6 years treated with antipsychotics in 2010 received at least one antipsychotic prescription from a child or adolescent psychiatrist.

The most common diagnoses among young people with claims for mental disorders in 2009 were attention-deficit/hyperactivity disorder in children aged 1 to 6 years (52.5%), children aged 7 to 12 years (60.1%) and adolescents (34.9%) and depression in young adults aged 19 to 24 years (34.5%).

“Olfson and colleagues cogently integrate epidemiologic findings with brain maturation findings concerning the rise of aggression and behavioral problems in late childhood and their decrease in later adolescence to explain the parallel trends in antipsychotic use. If this finding is true, then improving the quality and availability of treatments addressing underlying disturbances (eg, impulse control deficits, executive dysfunction, mood dysregulation) through this high-risk period should be a priority,” Christoph U. Correll, MD, of North Shore-Long Island Jewish Health System, and Joseph C. Blader, PhD, of the University of Texas, wrote in an accompanying editorial. “As a field we must accurately identify youth for whom antipsychotic risk is truly necessary by first exhausting lower-risk interventions for youth without psychosis.” – by Amanda Oldt

Disclosure: Olfson and colleagues report no relevant financial disclosures. Correll has served as a consultant and/or advisor to or has received honoraria from AbbVie, Actavis, Actelion, Alexza, Alkermes, Bristol-Myers Squibb, Cephalon, Eli Lilly, Genentech, Gerson Lehrman Group, IntraCellular Therapies, Janssen/Johnson & Johnson, Lundebck, MedAvante, Medscape, Merck, Novo Nordisk, Otsuka, Pfizer, ProPhase, Reviva, Roche, Sunovion, Supernus, Takeda, Teva and Vanda, and has received grant support from Bristol-Myers Squibb, Janssen/Johnson & Johnson, Novo Nordisk A/S, Otsuka and Takeda.