• Quote of the Day
    "Your living is determined not so much by what life brings to you as by the attitude you bring to life;
    not so much by what happens to you as by the way your mind looks at what happens."
    Kahlil Gibran, posted by David Baxter

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New Data: Antipsychotic Drug Use Growing Fastest Among Children

FRANKLIN LAKES, N.J., May 2, 2006 -- Children are the fastest growing category of users of antipsychotic drugs, according to an analysis by Medco Health Solutions, Inc. (NYSE: MHS) , a leading pharmacy benefit manager. While still a relatively low patient population, the number of children ages 19 and younger using antipsychotic medicines rose 73 percent from 2001 to 2005, far outpacing the 37 percent increase among 20- to 44-year- olds.

While the use of atypical antipsychotic drugs in children is not approved by the Food and Drug Administration (FDA), Medco's analysis of over 2 million insured Americans found that the number of children taking these medications has risen continuously over the past 4 years. This differs from trends seen in utilization of other behavioral medications including ADHD medications -- where use among children remained flat from 2004 to 2005 and antidepressants -- which saw a significant drop in use among children in that one-year period.

Children are receiving the latest generation of antipsychotics - known as atypical antipsychotics, including risperidone, olanzapine, clozapine, ziprasidone and quetiapine - at a much higher rate than adults. Of the patients prescribed antipsychotics, children received the newer atypical drugs 97 percent of the time rather than the older treatments. Adults received the newer antipsychotics 88 percent of the time. These drugs have been used as treatments for bipolar disorder, conduct disorder, ADHD, depression, Tourette's syndrome and other conditions.

"Children are receiving antipsychotics with greater frequency and that may be because they are viewed as less dangerous than the older medications and can be helpful for conditions that were previously treated with other medications," said Medco's chief medical officer, Dr. Robert Epstein. "However, these drugs are not without their risks. There is evidence that the risk of diabetes and metabolic disorders from using atypical antipsychotics could be much more severe for pediatric patients than adults, and there is a need for more studies to understand the long-term effects of these drugs on children."

Further findings from the analysis show that the growth in use among girls has been far greater than in boys. The number of girls under 20 on antipsychotics grew 103 percent from 2001 to 2005, as compared to boys whose use increased by 61 percent. During this same time period, there was a 15 percent increase in women 20 and over taking these medications, and a 9 percent hike for men of this age group.

While growth in use has been dramatic among children, adults still take these medications at a 69 percent higher rate than children. In 2005, nearly 7 children (0-19) out of one thousand were taking an antipsychotic, compared with 11 per 1000 adults. Among senior citizens 65 and older, the prevalence of antipsychotic use is three times that of children, at 21 per 1000.

Addressing pediatric antipsychotic use

There are a number of plan management programs that Medco offers its clients looking to address the cost and safety of these drugs and prevent unnecessary use of antipsychotics. Per member antipsychotic drug costs for children 19 and under have increased 196 percent, or nearly triple 2001's total. Much of this can be attributed to the increased use of atypical drugs, which are not yet available in generic form, as well as increased prevalence. Prior authorization and step therapy programs can help health plan sponsors control overall drug spending. Medco's drug utilization review programs and its RationalMed(R) Patient Safety System also monitor poly pharmacy, dosing and drug interaction issues for these medications, especially in patients with cardiac, metabolic and neurological conditions, such as hypertension, diabetes, and seizures.

"Doctors need to be judicious when prescribing antipsychotic drugs to children," Epstein said. "The use of these drugs can have the pediatric patient trading a behavioral condition for a lifelong metabolic condition that can lead to significant health complications."

Source
 

David Baxter

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I do think it is essential that doctors should be cautious in the use of ANY medications in developing children.

That said, what bothers me about articles like this one is the sensationalist use of the term "antipsychotic drug" in the headline.

The medications in question, as the article says later on, are in the family that is known as "atypical antipsychotics". As I've said elsewhere, I think this is an innacurate and unnecessarily frightening term to use to describe these medications, since, while in higher doses they are used to treat psychotic disorders, in lower doses they are also in the treatment of a range of issues including anxiety, depression, and sleep disorders.

There are always serious issues to be considered when prescribing ANY medications and that is especially true in children and adolescents. But I don't think we are well-served by the scaremongering approach of articles like this one.

Clarification: My comments here are aimed at the article and other articles like this, not at TSOW for posting it. I think it's an issue that needs to be discussed - what I am emphasizing here is one aspect of that debate.
 

ThatLady

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Any medications considered for use in children or adolescents should be considered with caution, I'd agree. I also agree that this scare-mongering tactic is for the birds. There are going to be times when even children need medications. We can't run screaming and leave the child to suffer.

I'm always reminded of the "underground" use of Thorazine. Ahhhh, hideous Thorazine. What a marvelous cure for intractable hiccups! ;)
 

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Another perspective on this issue is provided by a WebMD reviewer on Medicine Net

It seems the concern is over long term effects of using "atypicals" in children, as the available studies have been done only in adults.

Here's part of what they say:

Safety Issues

New safety concerns were raised this week in a series of articles published in USA Today. An investigation by the newspaper revealed that there were at least 45 unexplained child deaths between 2000 and 2004 in which an atypical antipsychotic drug was listed by the FDA as the "primary suspect."

Castle says there are "very real concerns" about the safety of the drugs, and his sentiments were echoed by Medco's Chief Medical Officer Robert Epstein, MD, in a news release.

"There is evidence that the risk of diabetes and metabolic disorders from using atypical antipsychotics could be much more severe for pediatric patients than adults, and there is a need for more studies to understand the long-term effects of these drugs on children," he says.

A drug industry group --- the Pharmaceutical Research and Manufacturers of America (PhRMA) -- says atypical antipsychotics are a useful tool in treating mental illness. Sharon Briger, PhRMA's senior director of clinical medical policy, issued this statement in a news release:

"Atypicals, a new class of antipsychotics that treat schizophrenia, bipolar and other mood disorders, represent an important advancement in treating patients of all ages with serious mental illnesses. Without medication, these disorders could lead to complications and even death. Whether or not a medicine is appropriate or not for a patient is a decision that should be left up to health care providers who are trained to recognize particular patterns and diagnose accordingly."

There is no doubt that many advances in treatment strategies have been made by off label use of meds, which led to studies being conducted and eventually the manufacturers got approval to modify the indications for those meds to include what was previously off label.

I guess the point of the article suggests a call for research into the long term use of atypicals in children.

Unfortunately when issues like these get into the lay press they tend to be sensationalized.
 

David Baxter

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I quite agree. There are many things, not all of them prescription medications or even over-the-counter medications, which may be safe or realtively safe for adults and not necessarily safe for children or teens. Assuming that because it's been tested on adults it's fine for children makes no more sense that assuming because it's been tested on rats it's safe for humans.

It's the sensationalism that I object to, and the unnecessary anxiety that's likely to create for parents of children who may be prescribed these medications. It's one thing to suggest that parents should discuss the issue with their doctors; it's another to be alarmist.

This is just part of my general beef with the sorry state of most journalism these days.
 

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This is just part of my general beef with the sorry state of most journalism these days

Call them what they are!


:eek:fftopic: Today's media is so competitive that a philosophy of "shock and awe" seems to be used to attract attention. {sigh}
 

Peanut

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I have two questions about this. My first question is, what is "atypical" about these antipsychotics? My second question is, when medications are considered to be "in the same family" is that in reference to their chemical structure and/or which neurotransmitters they affect...what is it about them that relates them? Alternately, what is different about them that they are in the same family but a different medication?

OK I guess I had three questions!

Thank you.
 

David Baxter

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"atypical" simply means they are different from traditional older "traditional" antipsychotics in terms of chemical composition and mode of action, as I understand it. I think it's a very misleading term.

when medications are considered to be "in the same family" is that in reference to their chemical structure and/or which neurotransmitters they affect...what is it about them that relates them? Alternately, what is different about them that they are in the same family but a different medication?
"in the same family" usually means somewhat related in terms of their usage and mode of action. However, using the SSRIs for example, while all or at least most directly affect serotonin uptake some like Effexor also affect norepinephrine uptake - Wellbutrin seems to primarily affect dopamine - but the simialrities are that all are affecting the directly and indirectly the available quantities of neurotransmitters to the brain.
 

Peanut

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Thank you for explaining that! Do you know what exactly antipsychotics affect in the brain? Does it have to do with slowing down over activity of some part of the brain?
 

David Baxter

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No, not precisely. All of these medications directly and indirectly affect brain chemistry but exactly how is beyond me - I'm no pharmacologist.
 

Peanut

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I'd say you're pretty close ;)

I believe that I've seen one case of an atypical used to control hyperactivity in a 4 year old child with autism. I must say that the results have been favorable thus far.
 

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their chemical structure and/or which neurotransmitters they affect

Atypical antipsychotics. Part I: Pharmacology, pharmacokinetics, and efficacy.

Markowitz JS, Brown CS, Moore TR.

Department of Pharmaceutical Sciences, Medical University of South Carolina, Charleston, USA.

OBJECTIVE: To compare the pharmacology, pharmacokinetics, and efficacy of the newer atypical antipsychotics with those of conventional agents and existing atypical agents. DATA SOURCES: Information was retrieved from a MEDLINE English-literature search from July 1986 to June 1998 and by review of references. Indexing terms included neuroleptics, atypical antipsychotics, clozapine, risperidone, olanzapine, sertindole, quetiapine, and ziprasidone. STUDY SELECTION: Comparative studies were selected when possible; placebo-controlled studies were included when data were limited on newer atypical antipsychotics. DATA EXTRACTION: Emphasis was placed on properly designed clinical trials that assessed dosage, expanded efficacy, enhanced adverse effect profile, and cost. DATA SYNTHESIS: Like other atypical antipsychotics, the newer agents have an enhanced 5-hydroxytryptophan/dopaminergic receptors (5-HT2/D2) affinity ratio and undergo extensive biotransformation. Risperidone and olanzapine demonstrate more favorable efficacy/adverse effect ratios than clozapine, sertindole, and conventional antipsychotics in nonrefractory and refractory schizophrenics. Future studies will more clearly define the role of quetiapine and ziprasidone in antipsychotic therapy. CONCLUSIONS: Data from controlled trials on efficacy and extrapyramidal side effects support risperidone or olanzapine as first-line agents for the treatment of schizophrenia. Pharmacologic and pharmacokinetic factors do not distinguish between agents sufficiently for drug selection.

Source: Pubmed
 

Peanut

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Thank you TSOW!! I knew you would come through with an answer!! You are the master of all things pharmaceutical!! Yay TSOW!!! :bubbly: :clap: :bubbly:
 

David Baxter

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I'm not sure which is funnier:

:bubbly: :clap: :bubbly:

or
Code:
:bubbly: :clap: :bubbly:
 

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