Antipsychotic Use Among Children Is Soaring
14 CommentsBy Ed Silverman // September 16th, 2008 // 8:24 am
A new study in the American Journal of Psychiatry found that Lilly’s Zyprexa and Johnson & Johnson’s Risperdal caused more side effects and were less effective for kids with schizophrenia than a 30-year-old generic pill that costs about one-fourth of the widely marketed atypical antipsychotics (back story).
Will the results change treatment practices? This remains to be seen, of course, but prescriptions have been climbing for the atypicals for years, as docs use the drugs to treat any number of behaviors and conditions - even unapproved uses, such as ADHD - despite serious side effects.
The chart, courtesy of Medco Health Solutions, illustrates recent prescribing trends - the use of all antipsychotics among children soared between 2001 and 2007. For kids younger than nine years old, usage jumped 81.5 percent and, among kids 10 to 19 years old, the increase was 91.2 percent.
Want to see the breakdown between boys and girls, and other age groups? Just click here or click on the chart to enlarge the numbers…
Glen Spielmans
This is very interesting data, Ed. Thanks for posting it. Can you describe more about the sample on which the data are based? How large of a database of patients? I’m guessing this does not include Medicaid patients, but maybe I’m wrong. Any additional information would be helpful so that this data can be placed in the most accurate context.
Ed Silverman
Hi Glen,
The sample size is listed at the bottom of the chart. It may be easier to read the figures by clicking on the part where I wrote ‘just click here,’ instead of the chart itself. Let me know you if you need anything else, though.
Cheers
ed
Dan A.
Can anyone explain how our society has atrophied to such a degree that we are harming our children in such a way? Try loving your children and being a great parent, instead of giving your children dangerous psychotropic drugs to exonerate yourself from being an apathetic and inadequate parent. I equate this trend with lobotomies decades ago. I equally blame the prescribers in these situations as well, and will debate this with them if given the chance.
This deeply saddens me. Harming children is a crime.
Salmon
Thanks Ed.
The numbers are truly amazing. The prevalence in both children and the elderly, are greater than in adults. With a prevalence around 1% in boys and 2% in the elderly.
Both the elderly and children are vulnerable populations that are at higher risk, and I mean that in several different ways. First they are more likely to have drugs forced on them by others. Their complaints are more likely to be ignored. They are more likely to be overdosed, and due to physiologic differences they are more likely to be at risk of serious toxicities (cardiac, neuropsychiatric and liver in elderly, and neuropsychiatric and possibly others in children).
The point being made that this data is from Medco and not medicaid is a good one. Medco is a private payer and as such there is less liklihood that rates would as high as in the populations medicaid/medicare populations where patients with psychiatric illnesses tend to wind up. I include children in this as these illnesses tend to run in families and also lower socioeconomic conditions and stressors may aslo be associated with illness and use in these populations.
Antipyschotics do work, some better than others. However, just because there is a psychiatric illness does not mean that use of an antipsychotic is the appropriate or even the best treatment. There is an growing body of literature that indicates that long term use even in psychosis is actually associated with worse outcomes.
One thing we need is good data in order to determine appropriate use. We also need appropriate labeling and training so that prescribers can monitor for and recognize emerging serious adverse events so that they are nipped in the bud before there are seriously nasty outcomes.
Salmon
Daniel Haszard
Lilly Zyprexa ‘ Chemical Straitjacket’ Use by Children.
Zyprexa,as well as the other atypical antipsychotics, are being prescribed for children, even though this is an unapproved, off-label use. Eli Lilly has been charged in allegedly pushing the drug for children in more than one state.
A report by Dr. Cooper at Vanderbilt University states that 2.5 million children are now taking atypical antipsychotics.
St. Petersburg Times Reports on Zyprexa A risky drug may get wider marketThe FDA may approve Zyprexa for kids, despite its significant side effects in adult use.
http://www.youtube.com/watch?v=uuK1t474ei4
Daniel Haszard Zyprexa patient who got diabetes from it.
Glen Spielmans
Ed,
Oops. I missed the sample size — now I see it. I am also curious about the nature of the sample. Does the sample include Medicaid patients?
Thanks!
Salmon
Glen,
The data is from Medco a private pharmacy benefit management company. So the data would have to be their paying insurees and not medicaid patients.
Medco was bought by Merck in the mid-late ’90’s and in addition to steering people to Merck drugs, Merck was using them for monitoring for postmarketing adverse events (think Vioxx).
Medco was spun off from Merck a few years ago.
Ed Silverman
Hi Glen,
Salmon is correct. I checked with Medco and I’m told the data does not include Medicaid participants.
Regards
ed
Glen Spielmans
Salmon and Ed,
Thanks! I figured that Medicaid wasn’t on there, but wanted to be sure. I recall seeing other data (though have since forgotten the source) suggesting that the surge in antipsychotics among children may be even greater among kids on Medicaid.
Lisa Van S
Ed,
I see a silver lining here. If you compare the 2005-2006 data to 2006-07 you see a dramatic decrease in prescriptions, especially in girls.
Lisa Van S
Ed,
But on the other hand, the prescribing of antipsychotics to children under medicaid are still increasing at an alarming rate.
atlex
Lisa,
I think you may be misreading the data. There was not a decrease in prescriptions among girls. It was still increasing, but at a somewhat slower rate.
Atlex
Lisa Van S
Atlex,
Thank You for pointing that out, I will look at it closer when I return.
Sam
Glen Spielmans:
Re “I recall seeing other data (though have since forgotten the source) suggesting that the surge in antipsychotics among children may be even greater among kids on Medicaid.”
See http://www.pharmalot.com/2008/02/nj-legislator-probe-antipsychotics-kids-medicaid/
which is just for New Jersey, but appears to be consistent with the general increase in Medicaid spending for atypical antipsychotics (and most other psychiatric drugs) as seen in the CMS data shown at http://www.psychdrugdangers.com/US/MedicaidPayments.html
This table shows the surge in Medicaid spending (304% from 2001 to 2005).
And on http://www.psychdrugdangers.com/US/MedicaidPsychDrugPayments.html you’ll see a 4,772% increase in Medicaid spending for psychiatric drugs from its inception in 1991 through 2005 with atypical antipsyhotics taking the lion’s share of the payouts accounting for 37% of the total.