I do not usually write so frequently about social issues, but the troubling news about off-label prescribing of powerful medications for children diagnosed with schizophrenia and autism spectrum disorder just keeps coming. Because many friends, relatives, and clients have children with those diagnoses, I feel compelled to alert parents to news that encourages them to seek a second opinion before agreeing to medicate their children with anti-psychotics prescribed by their children’s primary care physician or psychiatrist.
The New York Times reports on September 16, 2008 that a new government study published Monday has found that the medicines most often prescribed for schizophrenia in children and adolescents are no more effective than older, less expensive drugs and are more likely to cause some harmful side effects. The study’s authors suggest that older medication for treating the disorder should be included in treatment options.
The study is reported in The American Journal of Psychiatry. The Times states that the results will probably change treatment for an estimated one million children and teenagers with schizophrenia.
In the past 15 years, prescription rates for the newer drugs—“atypical anti-psychotics”—have increased more than fivefold for children. According to the Times, doctors now use these drugs to resolve temper tantrums and aggression in children with a wide variety of diagnoses.
Although the drugs have serious side effects, they continue to be prescribed “off-label,” meaning the FDA never approved them for these diagnoses. Recent studies have found that more than 80 percent of prescriptions for atypical anti-psychotics for children are to treat something other than schizophrenia, such as autism-related aggression, bipolar disorder or attention-deficit problems. The FDA has approved these drugs for some of the uses, but not all of them. Since many of these are prescribed for children on Medicaid, the government is paying the hefty bills.
One drug manufactured by Janssen, Risperdal, is the top selling anti-psychotic drug in the country—with a cost 5 times higher than the next most prescribed drug paid for by Medicaid and Medicare.
Two of the newer anti-psychotics, Zyprexa from Eli Lilly and Risperdal from Janssen, were compared to an older medication, molindone, in a study financed by The National Institute of Mental Health. All three relieved symptoms of schizophrenia, such as auditory hallucinations, in many young patients. Nevertheless, about half of the children in the study stopped taking their medication within two months because the drugs had no effect or were causing serious side effects, like rapid weight gain.
Safety is now called into question. Parents who have children on these drugs need to start asking questions.
Read the New York Times article Risks Found for Youths in New Antipsychotics
See, too, a New York Times report on bipolar children. New methods of diagnosis and treatment seem to be helping some children and their families. The Bipolar Puzzle - (What does it mean to be a manic-depressive child?) published on September 15, 2008
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