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.

18 comments
lahunken61
lahunken61

  Those drugs that are called "antispychotic", which are dopamine blockers, are not antipsychotic. They were used in the mental hospital gulags to devastate patients (prisoners) into compliance. Dopamine blockers block dopamine, the neurotransmitter of reward. Even the simple reward of changing position or facial expression goes unrewarded so that the victims writhe in torment, twitching and writhing for the reward that never comes, a writhing called tardive diskinesia. Campral and gabapentin are true antipsychotic drugs, by reducing the percentage of brain use, psychosis being professionally defined as using more than 10% of the brain. This brain percentage fact is being denied today to facilitate several coverups, also protecting the dopamine blocker  industry. When most of the mental hospital gulags closed down it left a huge stockpile of unsold dopamine blockers.  LSD works by blocking seratonin, the neurotransmitter of the brain's inhibitory neurons, thereby allowing more than 10% brain use, psychosis. Today's "antipsychotic" drugs, dopamine blockers, are "cruel and unusual punishment", forbidden by our Constitution.

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

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

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.

Micarl
Micarl

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.