Antipsychotics in Kids: The New York Times Gets it Right - and Wrong

John McManamy Health Guide
  • What I have to write about here is both extremely complex and highly emotionally-charged. If you are prone to anger and rash judgments, please don’t read any further. You can’t think when you are angry.

     

    Today, the New York Times published an article about drug companies behaving badly and psychiatrists who should know better. The story’s hook concerns young Anya Bailey, who was prescribed an antipsychotic for an eating disorder.

     

    There is no FDA indication for treating eating disorders with antipsychotics, but it is standard practice for doctors to prescribe medications off-label for all manner of illnesses.

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    With an antipsychotic, doctors often use the side effect as the healing effect. For instance, Seroquel’s strong sedative effect is regularly employed as an off-label sleep aid, so much so that I used to joke to my old support group, “Welcome to the Seroquel Users Club.”

     

    It is important to note that when Seroquel is used as a sleep aid it is prescribed in microscopically small doses – about 25 mg or so rather than the usual 300 mg.

    Some antipsychotics cause huge weight gain. You can see where this is going. Anorexic girl in doctor’s office – samples for Risperdal in medicine cabinet. Bad decision. Antipsychotics are never to be prescribed lightly. They are built for extremely serious mental disorders, usually in emergency situations, and come fully-loaded with onerous side effects.

     

    Poor Anya developed a serious back cramp, which she is still struggling with two years later.

     

    Drug Industry Money

     

    The New York Times article then reported that Anya’s supervising psychiatrist received some $7,000 in lecture fees from Johnson & Johnson, makers of Risperdal. The article went on to say that in the state of Minnesota – the only state that fully documents drug company pay-outs to doctors – while drug company payments to psychiatrists rose six-fold over five years, antipsychotic prescriptions to kids went up nine-fold. In addition, doctors who received $5,000 or more wrote three times the number of prescriptions for antipsychotics to kids than did doctors who failed to benefit from industry largesse.

     

    An outrage? Yes. Most definitely. In the nine years I have been engaged in mental health reporting I have extensively documented the corrupting influence the drug industry has over psychiatry. The pharmaceutical industry, with the acquiesence of the psychiatric profession, literally sets the psychiatric agenda, from professional education courses to the articles that appear in medical journals to what gets researched to treatment protocols to what type of drugs reach the market.

      


    Much of what goes on is totally unethical and contrary to the public interest. As I reported in a recent blog, the pharmaceutical industry is probably the only industry that pays no attention to its consumers, namely us.

     

    Please restrain your anger. There is a thinking zone ahead:

     

    Bipolar Kids

     

    The New York Times article then points out that antipsychotics are being prescribed to kids for the controversial diagnosis of early-onset bipolar. It was the New York Times that in February broke the tragic story of Rebecca Riley, age four, who died from an overdose of antipsychotics. One of the reporters of today’s article, Benedict Carey, was also involved in the Rebecca Riley story, as well as a story involving an Eli Lilly cover-up concerning Zyprexa.

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    But hold on one second. Bipolar kids are not anorexic teens. Whether one chooses to call these kids bipolar or not, something very serious and in dire need of medical intervention is going on. For those who have never witnessed the phenomenon nor have listened to the parents of these kids, here is an example from the third edition of “The Bipolar Child,” by Demitri and Janice Papolos:

     

    "One day, after [mother] Melissa refused to buy him candy, Eric [kindergarten age] ran out of the grocery store and attempted to run across the street. A few times he attacked her – hitting, kicking, and biting. Once, when sent to his room for a time-out, he opened the second-story window, knocked out the screen, and threatened to jump. Later he told his mother he thought he could fly."

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    In the nine years that I have been reporting on drug industry malfeasance, I have also been keeping close watch on the bipolar child controversy. I can assure you that bipolar in kids is not a fad diagnosis. Yes, there is considerable debate over what constitutes a bipolar diagnosis in kids (ironically, Dr Papolos sets more stringent criteria than for the adult diagnosis in all but actual length of the episode), and the public has every reason to be concerned about treating kids with meds not adequately tested in this population, but the fact remains that we have a clearly observable group of youngsters who exhibit bipolar tendencies, whose illness in fact is more severe than bipolar in adults.

     

    These are kids who don’t simply require a hug or strong parental discipline.

     

    For those who think we shouldn’t be giving these kids antipsychotics, here is the other consideration. Prescribing them an antidepressant for misdiagnosed depression or an ADHD med to calm then down is likely to make them much worse. In 2003-2004, the FDA conducted an investigation that resulted in safety warnings regarding issuing antidepressants to kids. Part of the warning included that before prescribing an antidepressants, kids should first be screened for bipolar.

     

    At one of the public hearings related to the FDA investigation, the Child and Adolescent Bipolar Foundation, run by parents (but with industry funding), testified that 20 percent of their members who responded to a survey were convinced that their own children became suicidal due to treatment with an antidepressant.

     

    Hard Decisions

     

    So now we come to the antipsychotic option. The leading psychiatrists I have listened to are not exactly enthusiastic about antipsychotics. After all, these are very imperfect medications, even in adults. Dr Papolos, for one, is getting good results on some of his patients employing a natural substance as part of the total treatment package. But he is not afraid to prescribe an antipsychotic.

     

    Parents are not exactly eager to stuff pills down their kids’ throats, either. One mother I listened to, in relation to her kid being treated with meds, had this to say: “They felt they had solved my problem. I felt I had lost my child.”

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    Her boy, incidentally, once jumped out of a van at fifty miles an hour.

     

    And therein lies the rub. We have kids prepared to jump out of vans and windows, who are unable to perform well in school, who lack the emotional control to make friends with kids their age, who don’t get invited to birthday parties, who lose out on their childhoods, and who doom themselves to having no chance at a decent teenhood or adulthood, if they are not treated.

     

    What do you do? How do you help these kids?

     

    The New York Times would have you do nothing.

     

    Please don’t get angry. Just think.

     

    Update: May 14

     

    This blog mistakenly creates the impression that anorexia is a trifling teen malady that does not rate medical treatment. Since posting this blog, I have researched anorexia and discovered that it is an extremely dangerous medical condition, with one of the highest death rates for mental illnesses. In certain situations, an antipsychotic is not only justified but may be the only viable treatment option. Although antipsychotics are not FDA-indicated for treating anorexia, the American Psychiatric Association, in its 2006 Practice Guideline for eathing disorders, recommends consideration of its use as adjunctive treatment in situations where other options are not working.

     

    Thus, with regard to antipsychotics for kids, the NY Times was wrong on all the clinical issues.

     

    Please check out my follow-up blog, Antipsychotics in Kids: The NY TImes Gets it Completely Wrong.



Published On: May 10, 2007