Use of second-generation antipsychotics (SGA) alongside other medications is growing rapidly among youth who are less impaired, according to a study published online in June in the Journal of American Academy of Child and Adolescent Psychiatry and reported this month in Psychiatric Services. Swedish and American researchers analyzed Medicaid data from 2004-2008 and found that, while SGA use overall increased by 22% among youth, about 85% of those people were taking multiple psychiatric medications. They also found that the biggest increases in use of multiple medications were occurring among youth who were having less serious psychiatric problems.
“The present study illustrates that the trend of increasing SGA use, which is occurring in the context of stable or declining use of other medication, is due in large part to sustained concurrent use of SGAs with other medications, an exposure that is known to have serious side effects and unknown long-term effects and drug-drug interactions,” stated the study. “Even more problematic is that the exposure to concurrent SGA is increasing disproportionately among youth with less perceived comorbidity and impairment. Such trends indicate a growth in off-label prescribing among children for whom evidence of benefit is lacking.”
“We knew that antipsychotic use was increasing among youth, but were surprised to learn just how often children with ADHD or depression receive an antipsychotic as part of their treatment, and when they do, it is for sustained periods of time,” one of the researchers told Psychiatric Services. “In a society that often doesn’t offer other services to respond to these behaviors, we should not be surprised at how quickly the use of antipsychotics has grown.”
In their study’s conclusion, the researchers cautioned that, “Concurrent SGA regimens will require further research to determine efficacy and potential drug–drug interactions, given a practice trend toward more complex regimens in less-impaired children/adolescents.”
More Youth Using Antipsychotics Concurrent With Other Medications (Psychiatric Services, August 01, 2014. DOI: 10.1176/appi.pn.2014.8a7)
Growth in the Concurrent Use of Antipsychotics With Other Psychotropic Medications in Medicaid-Enrolled Children (Kreider, Amanda R. et al. Journal of American Academy of Child and Adolescent Psychiatry. June 2014. doi:10.1016/j.jaac.2014.05.010)