Last month, the journal JAMA Psychiatry published a study suggesting that the use of antipsychotic medications may be fatal for children and adolescents who have not been diagnosed with psychosis. The study focused on patients who had been prescribed antipsychotic medications for behavioral disorders, such as ADHD, bipolar, or depression. In the majority of cases, these deaths were unexpected.
The retrospective study of young people enrolled in Tennessee’s Medicaid program examined nearly a quarter of a million patient records between January 1999 and December 2014. Children, adolescents, and young adults who were prescribed chlorpromazine (Thorazine, Largactil) or a similar drug at a dose of over 50 milligrams were 3.5 more likely to die than those taking a different medication. None of the deaths studied involved accident or suicide. Half were caused by heart failure or an accidental overdose. Furthermore, other than the behavioral issues for which they were prescribed the drugs, these young people were in good health.
“Patients should be selected very carefully, after consideration of both drug and non-drug alternatives. There should be a pre-treatment evaluation for factors that might amplify antipsychotic effects, such as cardiac conditions. These children and young adults should also be thoroughly monitored during treatment if they are prescribed a high-dose antipsychotic.”
In an editorial comment on Dr. Ray’s study, psychiatrist Dr. Barbara Geller, a former professor at Washington University in St. Louis, noted that antipsychotic medications can have a greater effect on young brains, as the pre-frontal cortex – the part of the brain that controls complex behavior – is not yet fully developed. This is an important consideration, as patients who are diagnosed with psychosis in childhood must often take such medications for decades. She also said that some deaths reported in Dr. Ray’s study may have been undetected suicides since ADHD and mood disorders can be a risk factor among young people.
Dr. Ray and his colleagues acknowledged that their research was limited because of its reliance on Medicare data. These records typically do not include information about factors such as weight, pre-existing cardiovascular conditions, or genetic predispositions. Nonetheless, Dr. Ray said, “Patients should be selected very carefully, after consideration of both drug- and non-drug-alternatives.” He recommended “…pre-treatment evaluation for factors that might amplify antipsychotic effects, such as cardiac conditions,” and careful monitoring of young patients being treated with a high-dose antipsychotic drug.
Death due to cardiovascular events are not the only risk of using antipsychotic medicines to treat behavioral issues. In 2013, Dr. Ray worked in another study, also published in JAMA Psychiatry, in which researchers discovered that such use of antipsychotic medications can put children at risk for type-2 diabetes. Antipsychotic medications that were implicated in diabetes risk included risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), and olanzapine (Zyprexa). The study found that for children who had taken such antipsychotics for as little as one year the risk of developing diabetes rose by as much as 200 percent.