Are Too Many Young Americans Getting Antipsychotics for ADHD?

Study shows rise in prescriptions for the powerful medications, even though they're not OK'd for this use

By Mary Elizabeth Dallas

Wednesday, July 1, 2015

WEDNESDAY, July 1, 2015 (HealthDay News) -- A growing number of teens and young adults are being prescribed powerful antipsychotics, even though the medications aren't approved to treat two disorders -- ADHD and depression -- they are commonly used for, a new study shows.

Researchers found that antipsychotic use rose among children aged 13 and older -- from 1.1 percent in 2006 to nearly 1.2 percent in 2010. And among young adults -- people aged 19 to 24 -- antipsychotic use increased from 0.69 percent in 2006 to 0.84 percent in 2010.

Of concern to some experts are the conditions for which many of these antipsychotic prescriptions are being written, namely attention-deficit hyperactivity disorder (ADHD) and depression. Currently, the U.S. Food and Drug Administration approves this class of drugs for psychiatric conditions such as psychosis, bipolar disorder, schizophrenia or impulsive aggression tied to autism.

But the new report finds that by 2009, 52.5 percent of younger children (aged 1 to 6), 60 percent of older children (aged 7 to 12) and about 35 percent of teens who got an antipsychotic were diagnosed with ADHD.

"ADHD is a main diagnosis being targeted by antipsychotic treatment in children and adolescents -- this is not an adequate diagnostic indication," said Dr. Vilma Gabbay, chief of the Pediatric Mood and Anxiety Disorders Program at the Icahn School of Medicine at Mount Sinai in New York City.

She noted that the new study showed that the rise in antipsychotic prescribing in teenagers and young adults was most pronounced in males. Since boys are more prone to ADHD than girls, "this trend explains the increased rates of males compared [to] females being prescribed antipsychotics," she said.

The study was funded by the U.S. National Institute of Mental Health (NIMH) and led by Dr. Mark Olfson, from the department of psychiatry at Columbia University in New York City.

There are many drugs classified as antipsychotics, but some include haloperidol, clozapine, risperidone, olanzapine and quetiapine. The researchers noted that clinical trials suggest that risperidone (Risperdal), when used with stimulants, can help reduce aggression in ADHD, but it is not approved by the FDA to treat the condition.

In their study, Olfson's team tracked data on antipsychotic prescriptions from a database that includes roughly 60 percent of all retail pharmacies in the United States. The database includes prescription information on approximately 1.3 million children, teens, and young adults, the researchers said.

"No prior study has had the data to look at age patterns in antipsychotic use among children the way we do here," study co-author Michael Schoenbaum, a senior advisor for mental health services, epidemiology and economics at the NIMH, said in an institute news release.

The study did find a downward trend in antipsychotic medications for some age groups. For example, in 2006, 0.14 percent of younger children between the ages of 1 and 6 were taking antipsychotics, compared to 0.11 percent in 2010. Among older kids -- those between the ages of 7 and 12 -- use of these drugs dropped from 0.85 percent in 2006 to 0.80 percent in 2010.

At the same time, however, antipsychotic use rose among older children and young adults. By 2010, 2.8 million prescriptions were filled annually for teens, the researchers said, while 1.8 million prescriptions were filled for young adults.

Many prescriptions were not written by child or adolescent psychiatrists, however. The study found that only about 29 percent of young children, 39 percent of older kids, 39 percent of teens and 14 percent of young adults got their antipsychotic prescriptions from such specialists in 2010.

Two conditions for which antipsychotic use is not approved by the FDA -- ADHD and depression -- were major reasons behind prescriptions for these medications. In fact, the study found that while prescriptions for ADHD were common, the most common condition among young adults prescribed these drugs was depression.

This is worrisome, Schoenbaum said. "Antipsychotics should be prescribed with care," he noted. "They can adversely affect both physical and neurological function, and some of their adverse effects can persist even after the medication is stopped."

The fact that many of those prescribing these drugs were not child psychiatrists was telling, Gabbay said.

"Only a minority of child and adolescent psychiatrists were involved in treatment," he noted.

Dr. Matthew Lorber is acting director of Child & Adolescent Psychiatry at Lenox Hill Hospital in New York City. He said there was good news and bad news from the report.

"Prescribing of this class of medications for children under the age of 12 has been decreasing, which is most likely a good thing due to their dangerous side effects," he said.

But Lorber agreed that more caution is needed in prescribing antipsychotics to children with ADHD.

Presumably, he said, "the intention of the prescribing physician is to address behavioral problems, aggression and mood changes, but it is unclear if the risks are being considered."

He said that for conditions for which antipsychotic medications are not approved, physicians should exhaust other treatment options first. Then, "if antipsychotics are necessary for children without psychosis or bipolar, it is recommended that they are used for brief interventions," only, Lorber said.

He also noted that the study only looked at prescriptions that were written -- it couldn't show whether the patients stuck with these powerful drugs or not. "It is common for parents to receive a prescription for their children but ultimately decide not to follow through in giving it due to their side effects," Lorber explained.

The study was published online July 1 in the journal JAMA Psychiatry.

SOURCES: Vilma Gabbay, M.D, chief, Pediatric Mood and Anxiety Disorders Program, and associate professor, department of psychiatry, Icahn School of Medicine at Mount Sinai, New York City; Matthew Lorber, M.D., acting director, Child & Adolescent Psychiatry, Lenox Hill Hospital, New York City; JAMA Psychiatry, news release, July 1, 2015; U.S. National Institute of Mental Health, news release, July 1, 2015

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