More Children Prescribed Atypical Antipsychotics
> 7/30/2007 10:48:15 AM

An increasing number of parents frazzled by their children's ongoing behavioral issues have turned in desperation to doctors whose solution to the problem involves the prescription of a controversial class of atypical antipsychotic medications. These medicines, created to treat major psychological conditions, have not been tested on children, and their efficacy remains uncertain. But because the drugs have been approved for general use by the FDA, doctors have the discretion to distribute them as they see fit, and an alarming number of the patients to whom they make their way are children.

Several different next-generation antipsychotic medications popped up in the mid-90's; they promised minimal side-effects in the course of the successful treatment of schizophrenia and bipolar disorder. This was a welcome development in the world of psychiatric treatment; the most severe cases of such disorders very often saw little benefit from available medications such as Thorazine or related substance treatments like Lithium. Where preceding generations of antipsychotics focused almost exclusively on the physical aspects of these disorders (hallucinations, paranoias, sensory delusions), the new medicines, informally labeled atypical, worked from a slightly different chemical mechanism, more directly affecting the brain's serotonin neurotransmitters and therefore minimizing the states of depression, withdrawal and low motivation so common to bipolar and schizophrenic patients. They seemed encouragingly effective in clinical trials and quickly gained FDA approval, but they were far from perfect, as disclaimers mentioning their negative effects on hypoglycemia were required by the agency. The drugs also carry a noted capacity for inducing weight gain.

Recently compiled statistics reveal a clear trend that has increased sharply over the last decade: prescribing these medications to children as young as 3 or 4 years of age. Though the drugs were designed to treated schizophrenia and bipolar disorder among adults, and they're still used mostly for that purpose, the majority of the children to whom they've been prescribed present cases of uncontrollably aggressive behavior that haven't responded to typical ADHD and mood disorder drugs. News of this practice has been around for some time, but serious clinical study on its risk factors has yet to emerge. Because of the very serious nature of reported side-effects, that research should begin immediately if doctors are to continue prescribing the medications to children.

Many parents reported their children developing persistent physical tics such as uncontrollable jerking motions and a pronounced sense of sedation. Several deaths of children who were taking these medications have been attributed to neuroleptic malignant syndrome, an extremely rare movement disorder. Overeating and, in some cases, lactation among boys have also been noted. Yet another concern is the possibility of dependence developing among medicated children who will most likely behave in even more extreme ways if deprived of their medications.  Some doctors insist that these drugs have led to spectacular results and "saved the lives" of some intensely disturbed children (despite leading them to gain as much as 100 lbs. in one year), and they would not be testifying to this fact if they did not believe it. So atypical antipsychotics may well hold significant promise for treating children with the most extreme symptoms of ADHD and various confrontational and destructive behavioral disorders. So-called "off-label" prescription practices pose significant ethical implications, however: should intense psychotropic medicines be used simply to control problem behavior, especially when the long-term implications of giving them to still-developing children are so unclear? Are there truly no viable alternatives for disruptive problem children? Until related research has been completed (and we have no signs that this will be the case anytime soon), doctors would be best advised to avoid prescribing these drugs to children. Extreme caution in such matters is the most effective approach.

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