New Medicaid data shows that antipsychotic use may dramatically increase the risk for diabetes in some children.
The largest study of its kind, conducted by researchers from The Children’s Hospital of Philadelphia’s (CHOP) PolicyLab, documents the significant risks to children who take prescription antipsychotic drugs. These medications belong to a powerful class of drugs designed to treat severe mental and behavioral health disorders. Examples of the second-generation (newer) antipsychotic drugs referenced in this study include Risperdal, Zyprexa, Seroquel, Abilify, Geodon, and Latuda. Results show that prescribing these antipsychotic drugs to children can significantly increase the risk of weight gain and type 2 diabetes by almost 50 percent. Children taking antidepressant medications in addition to antipsychotic drugs may have double the risk. Previous research has shown that one in three children taking antidepressants in the Medicaid program is also taking an antipsychotic drug at the same time.
Antipsychotic drugs traditionally were prescribed only to children diagnosed with schizophrenia or bipolar disorder, or to developmentally delayed children with severe aggressive behaviors. However, these medications are being increasingly prescribed to children with a wider range of symptoms without strong research demonstrating safety and efficacy for these issues. As a result, children with symptoms such as those seen in ADHD or disruptive behavior disorders are being medicated with these powerful medications, with little regard given to the potential short and long-term side effects.
The study, which used national Medicaid data on over 1.3 million children ages 10-18 with a mental health diagnosis, demonstrates that Medicaid-enrolled children are much more likely than privately insured children to receive prescriptions for these antipsychotic drugs. In fact, over 25% of all the children in the Medicaid system receiving prescription drugs for behavior problems them were prescribed antipsychotics. Most of these prescriptions were prescribed for less severe disorders than what they were originally designed to treat.
David Rubin, MD, MSCE, the study’s lead author and co-director of PolicyLab at CHOP states: “With such vast numbers of children being exposed to these medications, the implications for potential long-lasting harm can be jarring”. The research team recommends that families who are making medication and treatment decisions review overall treatment strategies and approaches before allowing children to take powerful antipsychotic medications. Children in immediate crisis, who may benefit from these medications over the short-term, should be placed on the lowest possible doses and closely monitored. They should be transitioned off these medications as soon as possible, once the behaviors have been addressed properly with other strategies. Numerous effective treatment approaches exist to support and reduce even the most challenging behaviors, and these avenues should be implemented in addition to medications.
Dr. Rubin goes on to say that, “At the end of the day, the approach to the individual child who is in crisis is still a case-by-case decision between a family and the treating provider. We can only hope that those decisions are made in full recognition of our findings, and that for some children, alternatives to these powerful medications—such as counseling or other supportive services, will be considered first.”
Rubin, D.M., Kreider, A.R., Matone, M., Huang, Y.S., Feudtner, C., Ross, M.E., & Localio, R. (2015). Risk for incident diabetes mellitus following initiation of second-generation antipsychotics among Medicaid-enrolled youths. JAMA Pediatrics, 169(4). doi:10.1001/jamapediatrics.2015.0285
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