Alert: Atypical anti-psychotics & kids

Medications have their place in the treatment of emotional conditions in children. However, staff child psychiatrists at the Lucy Daniels Center have long been concerned about the extent of use of these medications. One of our concerns has been that we are using some medications that affect many systems in the body, not just the brain, and we have little information about how these medications will impact a growing child over time. Many, like ourselves, are worried that we are conducting a large national experiment on our children.

Atypical anti-psychotics are one class of medication that child psychiatrists and other physicians use to treat emotional disturbances in children. These medications have been used with increasing frequency; some estimates are that over 1 percent of American children are receiving them. Seroquil, Zyprexa, Abilify, and Risperdal are some of the brand names of commonly used medications in this class. These medications have many known uncommon but serious side effects. The most common serious side effect has been the emergence of diabetes in a significant proportion of children receiving these medications, particularly Risperdal.

Two new studies, reported recently at the meetings of the American Academy of Child and Adolescent Psychiatry have raised alarm about the use of these medications for children and adolescents. A substantial proportion of children and adolescents who are receiving these medications, even for relatively short amounts of time and at relatively small doses, are developing components of what is called ‘metabolic syndrome.’ For the technically minded: this syndrome involves increase in trigliceride levels, decrease in high density lipid levels, increase blood pressure, weight gain, and increases in fasting blood sugar – all changes being to significant and problematic levels.

Twenty-seven percent of children in one of the studies had a metabolic syndrome (over three of these changes), while the random occurrence of metabolic syndrome in the population of children is around 3 percent (control group). A much higher proportion of children had significant changes that did not qualify for the level of a metabolic syndrome, but were still of high concern. Metabolic syndromes are associated with a high incidence of early onset diabetes, and researchers expressed their concerns about the potential for the emergence of cardiac disease as the years went on, since all five of these parameters are risk factors for cardiac disease.

We wish to emphasize that our view is that these medications have their place at times. Some children and adolescents need these medications despite the side effects, particularly those with schizophrenia or classical bipolar disorders. However, these medications are now being used rather widely, even for children with symptoms of ADHD! If you are a parent of a child for whom such medications have been prescribed, please do not make changes on the basis of this information. You may, though, consider a thoughtful discussion with your child’s physician, weighing the pros and cons in the light of developing information.

One of the two studies discussed above has been published to date: Christoph U. Correll, MD, and colleagues published their findings in the October 28 issue of the Journal of the American Medical Association.

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood in Cary and posted on the Carolina Parent Magazine's website, the Triangle's family resource - in print for over 21 years!  And online at www.carolinaparent.com.