High Doses of Antipsychotics Increase The Risk Of Death Among Children: Study

New research suggests that high doses of antipsychotics may place children and young adults at an increased risk of death from suicide and other causes. 

In a study published last month in the medical journal JAMA Psychiatry, researchers from the Vanderbilt University School of Medicine report that children who were new to antipsychotics and received high doses faced a significantly increased risk of death.

Researchers conducted a retrospective cohort study looking at Medicaid enrollees from ages five to 24 from 1999 through 2014. They looked for current and new antipsychotic medication use at doses of chlorpromazine, sold under Thorazine and other brand names, as well as a generic, higher than 50 mg, as well as those lower than 50 mg. The researchers also looked at children given non-antipsychotic medications such as mood stabilizers and antidepressants, as a control group.

The findings indicate that the incidence of death in the high dose control group was 146.2 deaths per 100,000 person-years. That compares to only 54.5 deaths per 100,000 in the control group and 67 deaths per 100,000 in the low-dose groups.

Researchers largely attributed the increased death rates to unexpected deaths, which were defined as deaths not due to an overdose, usually cardiovascular or metabolic causes. They also saw a slight increase in the rate of suicide.

“The findings suggest that antipsychotic use is associated with increased risk of unexpected death and appear to reinforce recommendations for careful prescribing and monitoring of antipsychotic treatment for children and youths and to underscore the need for larger antipsychotic treatment safety studies in this population,” the researchers concluded.

Child Antipsychotic Drug Side Effects

In April 2014, researchers from the University of Maryland found that about three times as many children who are in foster care and who have ADHD were prescribed antipsychotics; the most common used being Risperdal, followed by Abilify and Seroquel. The researchers concluded that many prescriptions for antipsychotics to children appears to be linked to socio-economic status and not good medical standards or science.

These medications are not approved for use in treating ADHD, but the study suggests that a number of groups of children in lower socio-economic groups are being prescribed Risperdal, Abilify, Seroquel and other similar drugs at a higher rate than their more advantaged peers.

Known as “chemical restraint,” the practice of using antipsychotics for behavioral modification has been mostly highlighted due to its use in nursing homes that treat elderly dementia patients, where it is considered a form of nursing home abuse. The FDA has warned nursing homes that antipsychotics do not help most dementia patients while increasing their risk of death.

A 2012 study published in the Archives of General Psychiatry found that children are now being prescribed antipsychotics, like Seroquel, Risperdal, Zyprexa and Abilify, at higher rates than adults. The study found that 31% of youths visiting a psychiatrist were prescribed an antipsychotic, compared to 29% of adults.

Studies regarding the effects of such drugs for children, especially when prescribed for unapproved uses, found increased weight gain and quadruple the risk of developing diabetes in children under the age of 18. Additional studies have also found that many other side effects may also include urinary problems and even death.

With not much evidence concerning its efficacy on youths; yet a higher prescribing rate, many youth advocates and health experts question the necessity of such prescriptions.

In 2011, an outside panel of experts voted to recommend that the FDA continue safety monitoring of antipsychotics and the risks for children. Such medications may pose a serious long-term health risk for children. The advisory panel has urged the FDA to conduct further in-depth studies on the weight gain side effects of atypical antipsychotics since 2009, some of which have been prescribed to toddlers as young as two years-old.