This month’s issue of JAMA Psychiatry ran an editorial commenting on recent research revealing that the majority of youth prescribed antipsychotics have not been diagnosed with a mental disorder. For these youth, the harms outweigh the benefits.
In July, research by Olfson et al. was made available online documenting the prevalence of off-label prescribing practices, the frequency with which antipsychotic medications are prescribed to children by non-psychiatrists, and the overall lack of psychosocial and therapeutic interventions.
To see MIA’s coverage of the Olson study, click here→
In their editorial, Christoph Correll and Joseph Blader, discuss the overuse of antipsychotics in youth in the United States. They warn that the potential side effects- including, “weight gain, and lipid and glucose abnormalities,” as well as diminished brain volume and neuronal density- outweigh potential benefits.
Olfson’s research suggests that a large number of antipsychotic prescriptions in youth are being used to control behavior and aggression. Correll and Blader point out that “other interventions, with lower adverse effect burdens, when implemented adequately, can avert the need for antipsychotic treatment.” They propose stimulants and family-based behavioral treatment as alternatives.
Fewer than 25% of all young people receiving antipsychotic prescriptions in Olfson’s study had received any psychotherapeutic services. Correll and Blader conclude from these results that antipsychotics “may be used hastily and for too long to suppress problematic behaviors while guidance for families about behavioral interventions that might curb such behaviors is disregarded.”
The authors recommend that prior authorization for antipsychotics prescriptions in youth may help to decrease the number of children receiving these drugs without a diagnosis. They point to a 2012 study that assessed the impact of Florida’s requirement of prior authorization for antipsychotics for children under age six, which found that the law decreased prescriptions and directed physicians to safer alternatives.
Correll, C. U., & Blader, J. C. (2015). Antipsychotic Use in Youth Without Psychosis: A Double-edged Sword. JAMA psychiatry. (Abstract)