Columbia U Study: Five-fold Increase Rx of Antipsychotics for children

The New York Times reports that an analysis of a national survey of doctors
prescribing practice by Columbia University psychiatrists found:

  1. "that antipsychotic medications were prescribed to 1,438 per 100,000
    children and adolescents in 2002, up from 275 per 100,000 in the two-year
    period from 1993 to 1995."

    2. "The total number of visits that resulted in prescriptions for the drugs
    increased to 1,224,000 in 2002 from 201,000 1993 to 1995."  

  2. "most of the patients were boys, predominantly Caucasian children, who
    were significantly more likely to see psychiatrists than other ethnic
    groups."

    The lead investigator, Dr.l Mark Olfson is quoted stating: "to me the most
    striking thing was that nearly one in five psychiatric visits for young
    people included a prescription for antipsychotics."
     
    Psychiatrists are prescribing the most toxic of all psychotropic drugs for one in five
    children though the drugs have not approved for children because they have
    not been found to be safe.

    Nowhere in the world do physicians have such a professional disregard for
    the welfare of children. American psychiatrists who prescribe highly toxic
    psychotropic drugs for children do so even though poor patient outcomes
    suggest that other treatment modalities must replace drugs because these
    drugs worsen and actually cause debilitating symptoms of chronic disease.

    It demonstrates psychiatry’s dependence on drugs and  the commercial impact
    on the profession’s reckless prescribing practices.
    How can one justify exposing children to drugs that have lethal risks and
    cause: chronic mental dysfunction: disrupt normal brain chemistry and
    interfere with normal functioning of the central nervous system, the
    hormonal system, the metabolic system, the endocrine system?
     The drugs induce de novo insulin resistance and diabetes mellitus; and
    cardiac abnormalities.  

    Furthermore, once these drugs are continually ingested, the body becomes
    drug dependent:  "The rate of discontinuation due to adverse events was
    significantly greater with olanzapine than placebo (13% vs 7%).   The term
    "Adverse’ appears 76 times in the Zyprexa label.

    The drugs carry black box warnings of lethal risks, and additional warnings
    about lethal risks. These include:

    "increased mortality in the elderly; Hyperglycemia and Diabetes Mellitus;
    Neuroleptic Malignant Syndrome (NMS); Cognitive and motor impairment;
    Disruption of the body’s ability to reduce core body temperature; Aspiration
    pneumonia is a common cause of morbidity and mortality; Suicide."
    "intentional injury" and "suicide attempt" are listed as occurring
    "infrequently"-not rarely!
        See: Zyprexa label:  http://pi.lilly.com/us/zyprexa-pi.pdf

    Additionally, Janssen Pharmacia’s antipsychotic, Risperdal (risperidone)
    carries warnings about the drug causing Tardive Dyskinesia:

    "A syndrome of potentially irreversible, involuntary, dyskinetic movements
    may develop in patients treated with antipsychotic drugs. Although the
    prevalence of the syndrome appears to be highest among the elderly,
    especially elderly women, it is impossible to rely upon prevalence estimates
    to predict, at the inception of antipsychotic treatment, which patients are
    likely to develop the syndrome. Whether antipsychotic drug products differ
    in their potential to cause tardive dyskinesia is unknown.

The risk of developing tardive dyskinesia and the likelihood that it will
become irreversible are believed to increase as the duration of treatment
and the total cumulative dose of antipsychotic drugs administered to the
patient increase. However, the syndrome can develop, although much less
commonly, after relatively brief treatment periods at low doses."   The term
"Adverse" appears 56 times on the Risperdal label See:
http://www.risperdal.com/active/janus/en_US/assets/common/company/pi/risperdal.pdf

The recent findings of the CATIE study confirm the severity of these drugs’ adverse effect profile.
It is not plausible, therefore, that those prescribing the drugs never noticed the harm being caused to patients.
See: http://www.ahrp.org/cms/content/view/132/80/

Last month, Yale University reported its highly controversial, so-called
"schizophrenia prevention study" failed to demonstrate a benefit. The
investigators have yet to report the adverse events that the study
subjects-some as young as 12-had suffered.

"We are using these medications and don’t know how they work, if they work,
or at what cost," said Dr. John March, a professor of child and adolescent
psychiatry at Duke University. "It amounts to a huge experiment with the
lives of American kids, and what it tells us is that we’ve got to do
something other than we’re doing now" to assess the drugs’ overall impact."

The inordinate influence of the pharmaceutical industry–both through an
army of sales reps and a highly paid band of academic "experts" who render
opinions-in lieu of evidence-has  shaped the practice of American
psychiatry.  These industry paid "experts" have designated antipsychotics as
"first line" treatment.

 What is the responsibility of the academic experts who issued consensus
statements about Treatment Guidelines recommending antipsychotics for
children–despite evidence the drugs are causing harm?

Two such consensus panels: the Texas Medication Algorithm Project (TMAP) and
another under the auspices of the American Academy of Child and Adolescent
Psychiatry, recommended antidepressants and antipsychotics for children. (to
be posted on the AHRP website)
 
 
Contact: Vera Hassner Sharav
veracare@ahrp.org
 
 
http://www.nytimes.com/2006/06/06/health/06psych.html?th=&emc=th&pagewanted=print
THE NEW YORK TIMES
June 6, 2006
Use of Antipsychotics by the Young Rose Fivefold
By BENEDICT CAREY

The use of potent antipsychotic drugs to treat children and adolescents for
problems like aggression and mood swings increased more than fivefold from
1993 to 2002, researchers reported yesterday.
 
The researchers, who analyzed data from a national survey of doctors’ office
visits, found that antipsychotic medications were prescribed to 1,438 per
100,000 children and adolescents in 2002, up from 275 per 100,000 in the
two-year period from 1993 to 1995.
 
The findings augment earlier studies that have documented a sharp rise over
the last decade in the prescription of psychiatric drugs for children,
including antipsychotics, stimulants like Ritalin and antidepressants, whose
sales have slipped only recently. But the new study is the most
comprehensive to examine the increase in prescriptions for antipsychotics.
 
The explosion in the use of drugs, some experts said, can be traced in part
to the growing number of children and adolescents whose problems are given
psychiatric labels once reserved for adults and to doctors’ increasing
comfort with a newer generation of drugs for psychosis.
 
Shrinking access to long-term psychotherapy and hospital care may also play
a role, the experts said.
 
The findings, published yesterday in Archives of General Psychiatry, are
likely to inflame a continuing debate about the risks of using psychiatric
medication in children. In recent years, antidepressants have been linked to
an increase in suicidal thinking or behavior in some minors, and reports
have suggested that stimulant drugs like Ritalin may exacerbate underlying
heart problems.
 
Antipsychotic drugs also carry risks: Researchers have found that many of
the drugs can cause rapid weight gain and blood lipid changes that increase
the risk of diabetes. None of the most commonly prescribed antipsychotics is
approved for use in children, although doctors can prescribe any medication
that has been approved for use.
 
Experts said that little was known about the use of antipsychotics in
minors: only a handful of small studies have been done in children and
adolescents.
 
"We are using these medications and don’t know how they work, if they work,
or at what cost," said Dr. John March, a professor of child and adolescent
psychiatry at Duke University. "It amounts to a huge experiment with the
lives of American kids, and what it tells us is that we’ve got to do
something other than we’re doing now" to assess the drugs’ overall impact.
 
But many child psychiatrists say that antipsychotic medication is the best
therapy available for children in urgent need of help who do not respond
well to other treatments. Without them, they say, many unpredictable,
emotionally unstable children would end up institutionalized.
 
Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University
and the lead author of the study, financed in part by the National Institute
of Mental Health, said the popularity of antipsychotic drugs might result in
part from "the fact that psychiatrists have few other pharmacological
options in certain patients."
 
The study, which looked at visits to pediatricians and other doctors, found
that psychiatrists were the most likely to prescribe antipsychotic drugs.
 
In light of how little these drugs have been studied in children, Dr. Olfson
said, "to me the most striking thing was that nearly one in five psychiatric
visits for young people included a prescription for antipsychotics."
 
The Columbia investigators analyzed data from the National Center for Health
Statistics survey of office visits, which focuses on doctors in private or
group practices. They calculated the number of visits in which an
antipsychotic drug was prescribed to people under the age of 21 and
collected information on patients’ medical histories. The total number of
visits that resulted in prescriptions for the drugs increased to 1,224,000
in 2002 from 201,000 1993 to 1995.
 
The researchers attributed some of the increase to the availability of a new
class of drugs for psychosis, called atypical antipsychotics, that were
introduced in the early and mid-1990’s.
 
The newer drugs, heavily marketed by their makers, were attractive in part
because they appeared less likely than older types of antipsychotics to
cause side effects like tardive dyskinesia, a neurological movement disorder
similar to Parkinson’s disease.
 
>From 2000 to 2002, the new study found, more than 90 percent of the
prescriptions analyzed were for the newer medications, and most of the
patients were boys, predominantly Caucasian children, who were significantly
more likely to see psychiatrists than other ethnic groups.
 
Some experts also pointed to an increase in the diagnosis of bipolar
disorder in children as a contributing factor. In recent years,
psychiatrists have begun to diagnose the disorder in extremely agitated,
often aggressive children with mood swings – short surges of grandiosity or
irritation that alternate with periods of despair. These symptoms in
children are thought to be related to the classic euphoria and depressions
of adult bipolar disorder.
 
At the same time, several of the atypical antipsychotics, including
Risperdal from Janssen and Zyprexa from Eli Lilly, won approval for the
treatment of mania in adults.
 
Some psychiatrists now routinely prescribe atypical antipsychotics "off
label" for young people thought to have bipolar disorder, and researchers
have begun to study the drugs in children as young as preschool age.
 
In the new study, about a third of the children who received antipsychotics
had behavior disorders, which included attention deficit problems; a third
had psychotic symptoms or developmental problems; and another third were
suffering from mood disorders. Over all, more than 40 percent of the
children were also taking at least one other psychiatric medication.
 
"We feel the medications are effective in children with bipolar and have
some data to show that," said Dr. Melissa DelBello, an associate professor
of psychiatry at the University of Cincinnati, who has done several studies
of the drugs.
 
Dr. DelBello said that the field "desperately needs more research" to
clarify the effects of the antipsychotic drugs but that many children
struggling with bipolar disorder got more symptom relief on these drugs than
on others, allowing psychiatrists to cut down on the overall number of
medications a child is taking.
 
Lisa Pedersen of Dallas, the mother of a 17-year-old boy being treated for
bipolar disorder, said he was unpredictable, hostile and suicidal before
psychiatrists found an effective cocktail of drugs, which includes a daily
dose of antipsychotic medication.
 
"Believe me, I would never choose having him on these meds," Ms. Pedersen
said in a telephone interview. "It’s not fun watching a child deal with the
side effects. But finding the right combination of medicine has made his
life worth living."
 
Yet this process is one of trial and error for many children. Ms. Pedersen
said her son had responded badly to the first two antipsychotic drugs he
received. And some experts think the way that psychiatric drugs are
prescribed is obscuring any understanding of underlying disorders and the
optimal treatments.
 
"If you’re going to put children on three or four different drugs, now
you’ve got a potpourri of target symptoms and side effects," said Dr. Julie
Magno Zito, an associate professor of pharmacy and medicine at the
University of Maryland.
 
Dr. Zito added, "How do you even know who the kid is anymore?"
 
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