News this week that as many as 100,000 prescriptions for anti-psychotics were written for Australian children in 2013 is cause for concern. Though the drugs may be appropriate in a small number of cases, their possibly irreversible side effects make them highly undesirable for use in children.
Anti-psychotic drugs have traditionally been prescribed to adults with severe mental illnesses, such as schizophrenia or bipolar disorder.
While these medicines are often the best option for treating such illnesses, they are also known as “dirty” drugs because their effects on the body and brain are broad. That’s because they weren’t specifically designed to target the symptoms they are prescribed for.
And they can produce a range of side effects. These include significant weight gain, increased risk for diabetes, movement disorders, heart disease and sexual dysfunction.
Children exhibit signs of psychotic illness in very rare cases. Prescribing anti-psychotic drugs in those instances is appropriate.
But these drugs are clearly not being reserved for rare cases of childhood-onset psychosis. They’re being prescribed for a range of other illnesses, including autism, obsessive compulsive, attention deficit and Tourette’s disorder. And they’re also being given to children with intellectual deficits who exhibit behavioural problems.
Anti-psychotics are increasingly being prescribed to children for a number of reasons.
In the last few decades, there’s been a shift from thinking of psychiatric illness as a result of environmental influences to understanding the biological basis of these disorders. So medical treatments for psychiatric illnesses are becoming more common.
It is also being recognised that the symptoms of the disorders, though often identified in early adulthood, are already present to a lesser degree in childhood. And there’s been a push to treat them earlier in the hope of improving prognosis.
It’s generally newer, second-generation anti-psychotics that are prescribed to children. These drugs are said to be atypical because they’re thought to be more effective and have fewer side effects. That makes them more palatable to give to young people.
But the reality is that they have side effects similar to those of the older drugs. And while there’s evidence of safety and efficacy for their short-term use, long-term outcomes are still unknown because studies don’t tend to extend beyond a year.
Anti-psychotics are often prescribed “off label”, which means they haven’t been approved for use in children. This is not always because the drug is dangerous but may instead reflect that prescription is uncommon for that group. But since a growing number of children are being prescribed anti-psychotics, it’s clearly time for research to ascertain whether this is appropriate.
Cause for concern
The most disturbing research in this area suggests long-term anti-psychotic drug use might shrink the brain independently of the effects of psychiatric illness. This finding has been reported in both macaque monkey and human studies.
The idea that, in addition to potentially dangerous side effects already reported, anti-psychotics might have this other effect on the brain is a terrifying thought for anyone taking the drugs. And it’s of particular concern for children because their brains are still developing.
Despite concerns about all the possible side effects of the drugs, the fact remains that some children suffer from very serious psychiatric illnesses that respond poorly to talk therapy alone. So people taking them should not suddenly stop.
A wholesale ban on children taking anti-psychotics is not the answer either. Rather, given the potentially severe side effects of these medications, guidelines on their administration should be reviewed.
It may be more appropriate for children to be prescribed anti-psychotics by specialists rather than general practitioners, for instance. Or it might be useful to ensure all other alternatives have been ruled out before anti-psychotics are prescribed. Another important step is to educate the parents and guardians of children who are given the drugs.
The increasing number of anti-psychotic prescriptions for children is worrying because of their significant and possibly irreversible negative side effects. This trend has increased much more rapidly than the supporting evidence for it; it’s time to review and evaluate the implications of this practice for children.