Potent antipsychotics given to children as young as two can lead to significant weight gain, according to new Canadian research into a class of drugs that one prominent American psychiatrist says are being used as tools of “social control.”
The number of children being started on second-generation antipsychotics, or SGAs, has grown exponentially, with prescriptions increasing 18-fold in B.C. alone between 1996 and 2011. Across Canada, between 2005 and 2009, antipsychotic drug recommendations for children and youth increased 114 per cent.
The new study was based on 147 children aged 10 to 16 treated at Hôtel-Dieu de Lévis hospital in Quebec between 2005 and 2013. The youth were part of a program created to track the metabolic effects of SGAs on children being treated with the mood-altering drugs for the first time.
Once reserved for schizophrenia in adults, the drugs are being prescribed “off-label” — used in an unapproved way or for an unapproved age range or dosage — to adolescent boys, as well as girls and younger children, for attention deficit hyperactivity disorder (ADHD), aggression and behaviour problems.
Half a dozen second-generation antipsychotics are marketed in Canada, including clozapine, risperidone and quetiapine. None have been authorized for use in children under 18, with the exception of aripiprazole (sold under the brand name Abilify), which is approved for treating schizophrenia in 15-to-17-year-olds.
University of Montreal researchers collected height, weight and blood samples, looking at the side effects when one drug alone was used, or switched or combined with other antipsychotics.
Overall, after 24 months of antipsychotic treatment, the children’s mean weight increased by 12.8 kg, or 28 pounds. Twenty-three per cent of the youth in the study became overweight or obese, nearly 10 per cent developed impaired fasting glucose — a type of pre-diabetes — and one developed full-blown diabetes.
The most frequent diagnosis that led to the prescription of the antipsychotics was “disruptive behaviour disorder” in children with ADHD, surpassing actual psychotic or mood disorders — that despite national guidelines recommending against the use of antipsychotics for behaviour problems.
The increase in weight and BMI, seen regardless of the type of SGA treatment used, “remains of great concern given that childhood obesity can adversely affect nearly every organ system,” the researchers warn in the study, published by the Canadian Journal of Psychiatry. Serious complications include high blood pressure, fatty liver disease and an increased risk of heart disease and stroke “from childhood onwards.”
It’s not clear why the children gained weight.
“Families tell me their kid went from drinking several litres of water to wanting to drink several litres of pop,” said Dr. Dina Panagiotopoulos, a pediatric endocrinologist at B.C. Children’s Hospital. One theory is the drugs affect brain chemicals that control hunger and satiety.
However, in a separate, yet-to-be published study, Panagiotopoulos’s team found children’s actual caloric intake doesn’t increase sufficiently to justify all the weight gain, and there is some suspicion the drugs affect a child’s resting energy expenditure — they burn fewer calories.
Panagiotopoulos has seen weight gains of as much as 50 lbs. (23 kg) in teenagers. Her own research shows antipsychotics are being prescribed to preschoolers as young as two.
“Some kids need these medications to function and to go to school and do well. I don’t want people to stop their children’s medication if they need it,” she stressed. “But there are things parents can do to live healthy lives and prevent some of these side effects, they just need to ask.”
She said children should be monitored every three months for the first year of treatment, and once a year, minimally, thereafter. “Often these kids will stay on these medications for years, and not be reviewed. We’ve had kids on them for over seven years.”
Dr. Allen Frances, professor emeritus at Duke University, said weight gains of “this enormous magnitude” can set children up for future diabetes and cardiovascular disease. “This is a terrifying study.”
Frances said antipsychotics are being “wildly and recklessly overused, very often by primary care doctors with little expertise, or time, under the influence of drug company aggressive marketing.”
He said the drugs are often prescribed to poor children and children in foster care. “It’s a form of social control. It’s medicalizing problems that are social problems.”
There may be rare instances where the behaviour problem is so extreme and resistant to any other form of treatment “that medication may be worth it, despite all the risks,” Frances added. “But this should be a very last resort, not a first reflex.”
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Drugs for bad behaviour cause alarming weight gain in kids, ‘terrifying study’ finds