Antipsychotics in Kids: The New York Times Gets it Completely Wrong

On Feb 1 this year, I turned up for a speaking engagement to NAMI San Diego. But first, the person who runs these meetings had two sad announcements: An individual who attended a nearby DBSA support group had committed suicide, and an advocate involved in NAMI in California had died of anorexia.

We bowed our heads in a brief moment of silence.

Last week, in a state of partial amnesia, in response to a New York Times story, I questioned the wisdom of a psychiatrist treating 12-year-old Anya Bailey, who had anorexia, with an antipsychotic. “Bad decision,” I wrote. “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.”

I also wrote: “Bipolar kids are not anorexic teens … Something very serious and in dire need of medical intervention is going on.”

My blog left the clear impression that anorexia is only a minor teen malady – certainly not on a par with early-onset bipolar – that barely rates medical attention. Far from the case. According to the NIMH:

“The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population. The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.”

These sobering stats make anorexia one of the most serious and potentially dangerous of all mental illnesses, affecting one in two hundred females. The illness hits virtually every organ system in the body, including the bones and the heart. It is also one of the most problematic to treat, often requiring long periods of hospitalization whose costs are not picked up by insurance.

As for treating the illness with an antipsychotic, despite the fact that there is no FDA indication for its use, the American Psychiatric Association, in its 2006 Practice Guideline for the Treatment of Patients with Eating Disorders, recommends considering a second-generation antipsychotic as adjunctive treatment “for those with severe, unremitting resistance to gaining weight, severe obsessional thinking, and denial that assumes delusional proportions.”

The APA acknowledges that there have been no clinical trials and only a pilot study or two.

The New York Times gives us no indication of Anya’s clinical condition at the time, other than to note she was “dangerously thin.” The article, however, provides full details on Anya’s painful back cramping caused by the Risperdal she was prescribed to gain weight.

The article also cites the lack of an FDA drug indication and paucity of study evidence, plus industry largesse to psychiatrists, but makes no mention of the APA Practice Guideline.

I should have known better. In the same article, the New York Times clearly misrepresented early-onset bipolar. No mention in the article was made of the fact that the illness is more severe in kids than it is in adults, nor did the article report on the type of behavior that so alarms their parents, such as jumping out of a van at 50 miles an hour.