Antipsychotic Prescriptions in Children Have Skyrocketed: Study

The dramatic rise of antipsychotic prescribing in youth occurred in conjunction with the illegal marketing of the drugs by their makers, resulting in multibillion-dollar settlements with the government

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Since 1993, the rate of antipsychotic drug prescribing to children increased by a factor of nearly eight, while prescribing to teens quintupled and in adults nearly doubled, according to a new study.

Virtually all of this growth was seen in prescriptions for second-generation, or so-called atypical antipsychotic medications, which are often dispensed off label — meaning the drugs are prescribed for conditions that they are not specifically approved by the government to treat. Once a drug is allowed on the market, however, doctors are at liberty to use the drug for other conditions: antipsychotics were originally approved to treat schizophrenia and bipolar disorder, but these disorders are uncommon in adults and even more rare in children.

There is much evidence that the vast increases in atypical antipsychotic prescribing in recent decades were fueled by the aggressive marketing tactics of drug companies. In recent years, every major manufacturer of atypical antipsychotics has been involved in the illegal marketing of the drugs (while doctors can prescribe drugs off label, it is against the law for drug makers to market them for off-label uses), each ultimately paying hundreds of millions to billions of dollars in fines for their sales and marketing tactics. The settlements with the U.S. government were among the largest in history.

(MORE: Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly)

In June, for example, Johnson and Johnson reportedly agreed to pay up to $2.2 billion for illegally promoting a variety of drugs, primarily the atypical antipsychotic Risperdal — and even that giant settlement with the government doesn’t resolve several other state lawsuits against the company, seeking billions more, for related offenses. In 2009, Eli Lilly was similarly made to pay $1.4 billion in fines related mainly to the illegal marketing of its antipsychotic drug Zyprexa — $615 million of that to settle criminal charges. Further, as we reported last year:

The charges against Lilly involved selling Zyprexa to doctors for use in children, despite the fact that it was not approved for this age group.

Bristol Myers Squibb paid $515 million in 2007 to settle charges that it also illegally pushed its antipsychotic Abilify to child psychiatrists. Pfizer paid out $301 million in a similar case related to its drug Geodon. AstraZeneca paid out $520 million to settle charges over the drug Seroquel. In all of these cases, the drugs were sold for unapproved use in youth.

The new study, published in the Archives of General Psychiatry, found that in 2005-09 nearly two thirds of all antipsychotic prescriptions for youth were written for ADHD and other disruptive behavior disorders; these conditions accounted for 34% of all antipsychotic prescriptions for teens. Yet there is little data supporting the safety or efficacy of the drugs for those conditions. The drugs’ effect on children’s brain development is also not known, but their side effect profile is clear: aytpical antipsychotics are known to cause weight gain and diabetes, side effects to which children seem particularly prone.

“As the actual evidence base that would support [such off-label prescriptions of antipsychotics] is scant to non-existent, and the evidence of permeating undue influence of pharma on prescribing practices in psychiatry is abundant, one is led to the conclusion that this is another example of irrational prescribing that can be traced to both the overt and tacit influence of [drug companies] on practitioners,” says Dr. Bruce Perry, a senior fellow at the ChildTrauma Academy. [Full disclosure: Perry and I have co-authored two books.]

Perry testified for the state of Texas in a case that resulted in a $158 million settlement with Johnson and Johnson in January to resolve claims that it fraudulently marketed Risperdal and swindled the state’s Medicaid program. One aspect of the case involved misleading claims about the drug’s effectiveness for behavior disorders in children.

(MORE: Marijuana Compound Treats Schizophrenia with Few Side Effects: Clinical Trial)

The new Archives study examined thousands of medical records in the National Ambulatory Medical Care Surveys, comparing antipsychotic prescribing rates in 1993-98 to those in 2005-09. It found that while, on a population level, adults received more prescriptions for antipsychotics from their doctors than did children or teens, the rate of prescription is skyrocketing in younger patients. By 2005-09, the proportion of youth and adult visits to psychiatrists involving antipsychotic prescriptions were roughly equal: 31% and 29%, respectively.

The authors conclude: “In light of known safety concerns and uncertainty over long term risks and benefits, these trends may signal a need to re-evaluate clinical practice patterns.” The authors also call for more clinical trials of antipsychotics’ effect on conditions they are already being used to treat.

The study was funded by the Agency for Healthcare Research and Quality, but some of the authors reported prior funding from industry.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

17 comments
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Daniel Haszard
Daniel Haszard

Risperdal  reproached.Same saga here as Eli Lilly Zyprexa.

 Johnson and Johnson is a trusted brand we associate with babies.

Risperdal,Zyprexa,as well as the other atypical antipsychotics, are being prescribed for children, even though this is an unapproved, off-label use. An estimated 2.5 million children are now taking atypical antipsychotics. Over half are being given them for Attention Deficit Hyperactivity Disorder,many of these foster children.

Weight gain, increases in triglyceride levels and associated risks for (life-long) diabetes and cardiovascular disease.

Eli Lilly made $67 BILLION on Zyprexa! *Tell the truth don't be afraid*  Daniel Haszard FMI

http://www.zyprexa-victims.com 

jnystrom54
jnystrom54 like.author.displayName 1 Like

I

just do not understand why more research is not being done in the neurofeedback

therapy for ADHD. My daughter has ADHD and I tried the meds to no avail. I have

found the program Play Attention and it works for us. Let me explain the

program: First, this program was developed by a teacher

who was sick and tired of seeing his ADHD

classroom kids on medications that were not working. Most all of the coaches

come from the school system.  The program

is based on neurofeedback. This is what I have learned and know to be true

because I saw immediate results, I mean I saw my daughter’s behavior change

within minutes during our first session.

When paying attention, the brain emits a signal. The signal is transmitted from the brain to an arm band, (that’s what your child

would wear) it’s like a tennis sweat band but is larger to fit up more on the

arm. That is how the signal is transferred to the computer, yup, it’s wireless.

After the data goes to the computer it is analyzed and you can then begin to play

games that teach your child’s brain to focus, improve memory, get rid of distractions, and we even work

on homework with it. You can

also keep a chart that helps you see how long she/he is paying attention and

increase their attention span by reinforcing the behavior while they play. By

paying attention they will move trucks, make fish swim etc.. My daughter loves

to play it. I don’t want to ramble and I’m not a scientist, so this is the best

way to explain it (I hope). Go to their website playattention.com.

I think the cost varies and they have a free webinar so you can see what it’s

all about, that’s how I did it. They are teachers and parents themselves. I

truly believe more research should definitely be done in this area.

 

Robert Bonan
Robert Bonan

We are now seeing the results of millions of children that were vaccinated to extreme (49 shots over 120 vaccine by age 6) causing many neurological disorders then compaunding the problem with over medicating them setting up our next generation of adults with Extreme Neurological disoders. Many of these over mediacted people have already commited suicide and millions of teens are being set up to have the same fate.  Google this ( urgent abused and over medicating children ) Then help us get the word out.

Talendria
Talendria

Please link the peer-reviewed study that associates vaccines with neurological disorders.  This hypothesis has been thoroughly debunked.

Talendria
Talendria like.author.displayName 1 Like

While I don't dispute the fact that Big Pharma is unethical and needs to be prosecuted (not just fined), you failed to acknowledge the other trend that's arisen in recent decades:  the rise of working mothers.  Children today spend too much time in chaotic daycare centers or in an unsupervised home, and it's teaching them antisocial behavior.  Addressing chronic behavioral problems is emotionally exhausting as well as time-consuming, which is why many of these families will resort to pharmaceuticals to deal with their children's behavior.  The bottom line is that children cannot raise themselves.  We need to stop genuflecting at the altar of feminism and start honoring a child's right to receive parental guidance.

iris weber
iris weber

Lady, my "mother" was at home all the time. I NEVER STOPPED PRAYING SHE WASN'T. Having been abused for many ,TOO MANY years to remember-while not being able to forget,SPARE ME and all others your sentimental bullshit about the right of the child to a "mother". HOW ABOUT THE RIGHT NOT TO BE ABUSED?????????

kathyalten
kathyalten

If my mother didn't work we would have starved. Instead of bleating against feminism and working mothers, perhaps you might hold irresponsible fathers who don't provide support to their families to account.

Talendria
Talendria like.author.displayName 1 Like

I'm not denigrating working mothers, especially not single working mothers who heroically provide for their families.  I'm pointing out a societal trend which has resulted in increasingly antisocial and overmedicated children.  There are many possible solutions to the problem:  the father can stay home (or, as you said, pay child support); the employer can agree to a more flexible work schedule; the government can hold daycare centers to stricter operational standards.  

If you'll harken back to this summer's feminist firestorm, the conversation currently centers on women "having it all," which ignores the needs of the child altogether.  Most people haven't put two and two together; they scratch their heads and wonder why we're seeing a spike in school bullying, autism, ADD, and other aberrant behavior.  It's because children cannot raise themselves, and daycare centers are often staffed by overworked, underpaid employees who truly couldn't care less about the children in their care.

davedarby
davedarby

@Talendria Very, very well said.  It isn't a feminine or a masculine issue, it's a parenting issue.  It isn't a government or school issue either though.  Parents need to take personal responsibility for the outcome of their children.  The results from inattentive and/or distracted parents is not random; it is very predictable.

No democratic "system" should hold parents back from their opportunity. Don't value the school systems - home school.  Can't home school because of work - change jobs or create a job.  Can't change jobs or create a job - move and/or learn to live on less.  Can't home school in your area - move.

Now of course, moving, changing jobs, realigning priorities isn't a simple, quick fix.  It takes time.  But we must accept that our choices create results and if we want to change the results, we must change our choices.  In the end, most families are conditioned to place a higher value on their house, their jobs and their leisure than on family and raising children.

I follow the credo that "where our time and money lie, so lies our values".

Parents that I coach know innately that their child's troubling behavior or performance is a result of lacking security and support - hence the guilt.  But they are torn in trying to have it all.  Some may argue that a single parent or low income two-parent homes are trying just to survive, not to have it all, but again, that comes down to choices.  In this case, the choice to have children without an adequate support system is a poor choice if parents have not demonstrated the ability to provide safety, food and shelter.  If a parent has demonstrated this and perhaps lost a job, then it's just a down cycle and can be remedied and achieved once again.

The bottom line is that behavior and personal growth (in self or children) always come down to time invested.  In the absence of time or clarity, parents choose the low-hanging fruit so readily provided to them by the AMA and pharmaceutical industry - drugs.  There's a big problem though - those drugs have adverse outcomes and create other issues so parents are left not knowing whom to trust or which way to turn.  They just want peace.

For peace, parents will have to rise up, connect the dots from pain to choices and begin to alter their choices to the extent that they rearrange their lives and their values to invest more time in themselves and their children.

kathyalten
kathyalten

I completely agree that government, the workplace, and fathers need to be more involved in the childcare issue. As a Canadian, I find it hard to believe the lack of support provided to mothers in the States. I've noticed many American commentators seem to feel that maternity leave is a form of communist entitlement. In Canada, it's just part of Employment Insurance, which is a payroll deduction paid by both the employer and employee. Fathers are also entitled to Parental Leave, though it must be balanced against what the mom uses. Governments bemoan the lack of women having babies to help support the older generations, but don't provide mothers with support when they choose to bear children.

Talendria
Talendria like.author.displayName 1 Like

I agree with everything you said, apart from your rejection of historical context. I'm blaming feminism because it marked the paradigm shift prior to which most American children had full-time parental care. I'm not suggesting we should revert to those days, but I am saying we need to press forward and find a better way to care for our children other than shunting them off to daycare for most of their waking hours. As I said, there are many solutions which don't involve chaining the mother to her stove again, and the first step is recognizing that the status quo is producing undesirable outcomes. People talk about childhood development issues in baffled tones as if they suspect there might be some neurotoxin in the municipal water supply, but I'm fairly certain the issue is sociological, not chemical.

I don't blame women. Most of us feel truly torn by our duty to fulfill our individual potential (and justify all the money we spent on college) while simultaneously helping our children achieve their potential. In most cases those goals are mutually exclusive, so we compromise and feel guilty. The point is that this problem can't be solved by women as individuals. The government, the workplace, the school system, and fathers need to evolve to support this new parenting paradigm. As with many other quality of life issues, Europe is far ahead of us on this one.

kathyalten
kathyalten

I don't feel feminism has anything to do with the problems you mention. How does feminism make doctors overdiagnose ADD and other disorders, or cause doctors to overprescribe medications? How does feminism cause bad parenting? Bullying and certain other behavioral problems are caused by the culture of selfishness and rudeness that has been allowed to develop in society. When children are vicious little brutes it's because their parents raised them to be that way. Please note: parents, not mothers. Why do fathers get a free ride?

If you'll recall how women and children were treated before the advent of feminism, perhaps you might change your views. We were possessions, not allowed to work, not allowed to advance our educations, not allowed to divorce brutal men. We were treated as much of the muslim world still treat women. Generations of women before me fought hard to receive equal treatment, and I won't give it up, nor have my daughters treated as "less than".

"Having it all" is something promoted by the media to make regular people feel bad about their lives. It's promoted to enourage the rampant consumerism so prevalent in modern society. For me, part of having it all is having well adjusted, nice children who grow up to become productive members of society. It's not having the latest electronic gadgets or a 2800 square foot house with servants attached.

People need to get their priorities straight, which has nothing to do with feminism or a lack thereof. Society also needs to reset its priorities, which glorify consumerism and the cult of celebrity. Perhaps if those in power cared less about their corporate buddies and more about the actual human beings they claim to represent, children might see some actual benefit, as opposed to the pharmacuetical companies with thier endless medical solutions to non-problems.

Micarl
Micarl like.author.displayName 1 Like

Why do parenting when you can just buy your kids drugs.

Some of these cases are truly legit, but having been a teacher and seeing so many kids on drugs, the number or % of times you can equate the child being drugged with the number of parents too busy to raise their children, or couldn't be bothered to, was mind boggling.

kathyalten
kathyalten like.author.displayName 1 Like

Interestingly, it is the teachers who often point out to a parent that their child may have ADD or other learning disabilities. When my teen was in grade 4, her teachers asked me to have her tested for learning disabilities, and to have her put on Ritalin. She was dignosed with ADHD by my family doctor, who prescribed Ritalin, which didn't work. We then went to Concerta, which seemed to help focus her. I personally thought she was just being a child, a very active one perhaps, but not in need of medication. The school and the doctor were the ones who wanted to medicate her, not me, but you're a bad parent if you don't follow the doctors advice.

I had of course done my own research on the benefits of Concerta, which appear to be nil once puberty hits. I stopped the Concerta once she hit puberty, and haven't looked back since. I felt that my daughter had to learn how to deal wih her issues without medication, and she has. In some ways it was helpful to have her diagnosed as needing medication, as the school makes allowances for her and she is allowed more time for tests, etc. But I don't believe she ever truly needed to be medicated. Modern society does not accept that normal children are active and easily distracted, especially boys. They want and expect children to be perfect little robots, with medication liberally applied to keep them that way.

Talendria
Talendria like.author.displayName 1 Like

Agreed.  Teachers are often the ones pushing for diagnosis/medication, because the classroom is out of control.  And to be fair, it's hard to discipline children at school if they're not disciplined at home, so I do have some sympathy for the teachers.  (I'm not saying your child isn't disciplined, but the group dynamics of a large classroom can cause even well-behaved kids to act out when other kids are being naughty.  One bad apple really can spoil the bunch.)  

You're correct that studies have shown drugs to be effective only in the short-term, so I regard them as a stop-gap measure for truly troubled children.  In the long-term there's no substitute for behavior modification, unless the child has a severe psychological problem, which most of them do not.  In seven years of volunteering in an elementary school and coaching Little League, I've only met two children whom I thought should be medicated.  

Most children diagnosed with ADD can be cured with exercise and chores.  It's a lifestyle disease in most cases; they spend too much time overstimulating their nervous system with games, TV, and other electronics and not enough time doing physical labor or playing outside.  My kid's behavior improved dramatically when I made him responsible for Swiffering the floor, putting away the groceries, and taking care of the dog.

It's frustrating that doctors prescribe these medications willy nilly, because most parents respect expert advice.  Also, kids don't come with an instruction manual, and talking to a developmental psychologist for child-rearing tips will cost you about $100/hour.  So it's not hard to see why many children are being medicated.

davedarby
davedarby

@Talendria You have a strong grasp on what it is I am working to teach parents and your communication skills are highly professional.  There doesn't seem to be a way to private message you, but I am recruiting for a mentoring network that is designed to get society away from 'quick fixes' and instead re-institute a time-honored and successful tradition of investing time with people in the shape of paid individual and group mentoring (business, individual, family/parenting) using a facebook-like social network.  We have a review process, but if you are even slightly interested in this methodology and in helping others, please email me:  outreach at l-i-f-e m a p p dot com (without dashes or spaces).  You can also learn more about my methods and intent personally at my username dot com.  Thanks!