Monday, December 4, 2023

Youth Taking Antipsychotics Not at Increased Risk of Death

Physically healthy youth aged 5 to 17 years who begin taking antipsychotics for conditions that do not involve psychosis appear to be at no greater risk of death than those initiating other medications. This was one of several findings of a recent article in JAMA Psychiatry.

“Antipsychotic medications have potentially life-threatening cardiovascular, metabolic, respiratory, sedative, and other adverse effects in both children and adults, although many of these are infrequent,” wrote Wayne A. Ray, Ph.D., of Vanderbilt University School of Medicine and colleagues. “This finding suggests that antipsychotic medication–related fatalities are rare in healthy children without psychosis.”

Ray and colleagues used the Medicaid Analytic Extract, a national repository of data from the Medicaid and Children’s Health Insurance Program, to identify all individuals aged 5 to 24 without psychosis who initiated antipsychotic treatment between January 2004 and September 2013. Individuals diagnosed with a serious medical illness in the past year were excluded from the analysis. The researchers divided these patients into low- and high-dose antipsychotic groups, using 100 chlorpromazine mg daily or equivalent as the cutoff.

As a control group, the researchers identified similarly aged patients who began taking alternatives to antipsychotics for such conditions as attention-deficit/hyperactivity disorder, depression, or disruptive behaviors, including antidepressants or lithium.

A total of 2,067,507 children and young adults who filled nearly 22 million prescriptions (about 8.3 million antipsychotic prescriptions and 13.5 million control prescriptions) were included in the analysis.

Overall, the researchers found that patients taking low-dose antipsychotics were no more likely to die than those who took control medications; however, those who took high-dose antipsychotics were at a 37% increased risk of death compared with those who took the control medications.

When breaking down the data by age groups, Ray and colleagues found no increased risk of death among 5- to 17-year-olds taking high-dose antipsychotics. Eighteen- to 24-year-olds taking high-dose antipsychotics had a 68% increased risk of death. The heightened death risk in the high-dose group was significantly associated with drug overdoses and unintentional injuries. The researchers found no association between antipsychotics and suicide deaths or cardiovascular/metabolic deaths.

“[C]aution may be indicated when prescribing antipsychotic medications for young adults without psychosis who are receiving opioid treatment or who have substance use disorders,” Ray and colleagues wrote. “Additional research is needed, particularly for nonfatal overdoses, which are much more frequent than deaths in children and young adults.”

To read more about this topic, see the Psychiatric News article “Antipsychotic Use in Young Children Declining, but Concerning Trends Remain.”

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