More Children Prescribed "Atypical" Antipsychotics
> 7/30/2007 12:41:45 PM

An increasing number of parents frazzled by their children'songoing behavioral issues have turned in desperation to doctors whosesolution to the problem involves the prescription of a controversial class of "atypical" antipsychotic medications.These medicines, created to treat major psychological conditions, havenot been tested on children, and their efficacy remains uncertain. Butbecause the drugs have been approved for general use by the FDA,doctors have the discretion to distribute them as they see fit, and analarming number of the patients to whom they make their way arechildren.

Several different next-generation antipsychotic medications popped up in the mid-90's;they promised minimal side-effects in the course of the successfultreatment of schizophrenia and bipolar disorder. This was a welcomedevelopment in the world of psychiatric treatment; the most severecases of such disorders very often saw little benefit from availablemedications such as Thorazine or related substance treatments likeLithium. Where preceding generations of antipsychotics focused almostexclusively on the physical aspects of these disorders (hallucinations,paranoias, sensory delusions), the new medicines, informally labeled"atypical," worked from a slightly different chemical mechanism, moredirectly affecting the brain's serotonin neurotransmitters andtherefore minimizing the states of depression, withdrawal and lowmotivation so common to bipolar and schizophrenic patients. They seemedencouragingly effective in clinical trials and quickly gained FDAapproval, but they were far from perfect, as disclaimers mentioningtheir negative effects on hypoglycemia were required by the agency. Thedrugs also carry a noted capacity for inducing weight gain.

Recentlycompiled statistics reveal a clear trend that has increased sharplyover the last decade: prescribing these medications to children asyoung as 3 or 4 years of age. Though the drugs were designed to treatedschizophrenia and bipolar disorder among adults, and they're still usedmostly for that purpose, the majority of the children to whom they'vebeen prescribed present cases of uncontrollably aggressive behaviorthat haven't responded to typical ADHD and mood disorder drugs. News ofthis practice has been around for some time, but serious clinical studyon 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.

Manyparents reported their children developing persistent physical ticssuch as uncontrollable jerking motions and a pronounced sense ofsedation. Several deaths of children who were taking these medicationshave 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 thepossibility of dependence developing among medicated children who willmost likely behave in even more extreme ways if deprived of theirmedications.  Some doctors insist that these drugs have led tospectacular results and "saved the lives" of some intensely disturbedchildren (despite leading them to gain as much as 100 lbs. in oneyear), and they would not be testifying to this fact if they did notbelieve it. So "atypical" antipsychosis may well hold significantpromise for treating children with the most extreme symptoms of ADHDand various confrontational and destructive behavioral disorders.So-called "off-label" prescription practices pose significant ethicalimplications, however: should intense psychotropic medicines be usedsimply to control problem behavior, especially when the long-termimplications of giving them to still-developing children are sounclear? Are there truly no viable alternatives for disruptive problemchildren? Until related research has been completed (and we have nosigns that this will be the case anytime soon), doctors would be bestadvised to avoid prescribing these drugs to children. Extreme cautionin such matters is the most effective approach.

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