Alternative Therapies Should Be Considered Before Antipsychotics for Children, Report Says

Despite the vulnerability of youth to the potential side effects of antipsychotics, previous studies suggest clinicians have increasingly prescribed these medications to children and adolescents in the United States over the past 15 years. In an article published this week in Psychiatric Services in Advance, researchers described the potentially serious short- and long-term side effects of antipsychotics and proposed alternative therapies for treating children with behavioral and emotional disorders.

While antipsychotics are approved as first-line treatments for children with schizophrenia, bipolar disorder, and severe behavioral problems associated with autism, “they are often used off label to control disruptive behaviors of children without autism and treat mood problems of children without bipolar disorder,” Robert Drake, M.D., Ph.D., a professor of psychiatry at Dartmouth College, and colleagues wrote. “Antipsychotics have serious short-term side effects among children, and more extended, longitudinal data on their safety in this particularly vulnerable age group do not exist.”

Short-term studies suggest that the side effects of antipsychotics in children include excessive weight gain, symptoms linked to metabolic syndrome, and neurological, cardiovascular, and hormonal effects. Additionally, while the long-term effects of the medications on children’s social functioning are unknown, recent evidence suggests that cumulative exposure may decrease social functioning among young adults.

As an alternative, short-term psychosocial interventions including parent-child interaction therapy, cognitive-behavioral techniques, and other methods “have well-established effects that rival those of pharmacological treatment” that could benefit children with disruptive behaviors and aggression, the study authors wrote.

To curb the use of antipsychotics in children, the authors proposed that additional steps are taken to educate prescribers of alternative medication strategies, psychotherapists of evidence-based interventions for disruptive behaviors, as well as enhance guidelines to monitor prescribers’ clinical behaviors and improve compliance.

For related information, see the Psychiatric News article “Study Finds Overall Increase in Youth Prescribed Antipsychotics.”

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