Antipsychotic Drugs Often Inappropriately Prescribed for Children and Teens: Study

Researchers found that most “off-label” prescriptions for the psychoactive medications were for the treatment of autism, which has not been established as safe and effective.

Less than half of children and adolescents prescribed antipsychotic medications have a documented medical need for the drugs, according to a new study that raises concerns about overprescribing among youth.

According to data published in the BMJ Mental Health on July 8, about 20% of children and teens were prescribed first-generation antipsychotics like Haldol and Thorazine, despite having no recorded history of mental health conditions that would warrant the treatments.

The study also highlights widespread off-label prescribing of newer antipsychotics, such as Seroquel and Zyprexa, for uses that have not been determined to be safe and effective by federal regulators.

While drug makers are barred from promoting these uses, physicians can legally prescribe them at their discretion. However, these medications may carry serious risks, especially for young patients, including sedation and movement disorders.

To address these concerns, the U.K.’s National Institute for Health and Care Excellence (NICE) has issued guidelines requiring regular monitoring during the first year of treatment before transferring young patients to general care. The new study suggests that many prescribers are not adhering to these safety protocols.

The study was led by Dr. Yana Vinogradova, who examined the use of antipsychotic medications among children and adolescents who were prescribed the treatment for four mental health conditions: psychosis, bipolar disorder, autism spectrum disorder and Tourette’s syndrome. Researchers reviewed whether patients received proper aftercare and physical health monitoring, including routine bloodwork.

Analyzing data from 2006 to 2021, the study found that antipsychotic prescribing increased among children and teens during the 15-year period. However, only 47% of adolescents prescribed the drugs had a diagnosed mental health condition recognized by U.K. guidelines as warranting antipsychotic treatment.

Researchers also found that 19% of youth prescribed antipsychotics had no relevant mental health diagnosis at all. Of those deemed inappropriate prescriptions, more than 60% were linked to autism, a condition often treated off-label with antipsychotic drugs despite limited regulatory approval.

The findings also revealed widespread lapses in follow-up care. More than half of patients did not receive recommended blood testing within two years of starting treatment, with monitoring rates even lower among those prescribed antipsychotics for off-label uses such as autism or Tourette’s syndrome.

The researchers expressed concern about inconsistent interpretation and implementation of U.K. prescribing guidelines across clinical settings. They also suggested that the complexity of the recommended protocols may contribute to poor adherence among healthcare providers.

Antipsychotic Drug Risks

The NICE guidelines were established after prior research highlighted serious risks antipsychotic drugs may pose to both teens and adults.

A study conducted by researchers from the University of Maryland School of Pharmacy warned more children and teens are using multiple antipsychotic drugs at the same time. The rate grew by nearly 10% from 2015 to 2020. Using multiple drugs at the same time, especially several antipsychotics, increases the risk of serious side effects.

Other studies have linked large doses of antipsychotic drugs, like Seroquel or Risperdal, to an increased risk of developing tardive dyskinesia, a neurological condition that causes involuntary movements.

Researchers from Hong Kong concluded the antipsychotic drug lithium can increase the risk of developing thyroid and kidney problems among bipolar disorder patients, with study data indicating the effects were seen even at low doses.

Recently, a lawsuit was filed against the manufacturers of Risperdal and Zyprexa claiming the popular antipsychotic drugs caused breast cancer in a California woman. The lawsuit raises concerns about the failure of the companies to adequately disclose potential side effects users may face from taking antipsychotic medications.

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