Antipsychotic Drug Prescriptions for Kids Soaring

(HealthDay News) -- The use of antipsychotic drugs prescribed for children has soared six-fold since the early 1990s, a new report finds.

The surge appears to be largely due to doctors who prescribe the drugs to treat mental illnesses -- including behavior disorders and mood disorders -- that don't have a psychotic component. In many cases, the U.S. government frowns on such "off-label" treatment, but it is legal.

The report findings are a cause for concern, because it's not clear how the drugs work in children, said study lead author Dr. Mark Olfson, professor of clinical psychiatry at Columbia University College of Physicians & Surgeons.

"They've been used in ways that haven't been as extensively studied and for which they haven't been approved by the FDA (U.S. Food and Drug Administration)," Olfson said. "Whenever the practice gets out in front of the science, there's reason for concern."

Olfson and his colleagues examined figures from annual federal surveys of doctors about their practices. The study findings appear in the June issue of the journal Archives of General Psychiatry.

Based on the survey results, the researchers estimate that the number of office visits by children 20 and younger that included prescriptions for antipsychotic drugs grew from 201,000 in 1993 to 1.2 million in 2002. About 18 percent of visits to psychiatrists resulted in prescriptions for antipsychotic drugs.

Antipsychotic drugs are designed to treat people with psychotic disorders that give them a warped sense of reality. But the study shows that doctors are using them for other purposes for children, including behavior disorders (38 percent) and mood disorders (32 percent).
In some cases, the drugs aren't federally approved for treatment of those conditions, but doctors can still legally prescribe them for "off-label" uses.

Children with behavior disorders may be threatening or intimidating other children, Olfson said. What's more, the decline of psychiatric hospitalization of children is forcing psychiatrists to treat children with more severe symptoms. "Part of it is, also, that there aren't a lot of other alternatives to help with the management of kids who have serious behavioral problems," he said.

But it remains unclear exactly how antipsychotic drugs affect children, said Dr. William Cooper, associate professor of pediatrics at Vanderbilt Children's Hospital, who's familiar with the study's findings.

"For things like attention-deficit disorder, depression and bipolar disorder, the bottom line is we don't know whether they work for those conditions in children, and we don't know what side effects they have in kids," Cooper said.

Some newer antipsychotic medications seem to cause weight gain, diabetes and heart rhythm irregularities, Cooper said.

Still, when psychiatrists "find themselves faced with a child having out-of-control behavior, they may think there's not a lot of other options," he said.

More information
Visit the American Academy of Child & Adolescent Psychiatry for more on psychiatric medication for children.

Study May Explain How ADHD Treatments Work

(HealthDay News) -- Commonly prescribed drugs to treat attention deficit hyperactivity disorder (ADHD) seem to have an effect on dopamine released in the brain of people with the disorder.

New German research shows that different amounts of dopamine, which is related to positive reinforcement-based learning and behavior, are released in the brains of people treated for ADHD, compared with those untreated for their disorder.

"The significant difference we found between treated and untreated ADHD patients provides an important hint on the effect of the most commonly prescribed drug for this disease, which has long baffled and frustrated parents and physicians," Felix M. Mottaghy, a research fellow at the University of Ulm, said in a prepared statement. Mottaghy added that this is the first study to identify the positive effect that ADHD drugs have on the brain's dopamine system -- although that's long been a theory.

"This is a very preliminary, basic science study... however, future studies of the dopamine system could aid differential diagnosis in hyperactive children," said Mottaghy.

Researchers tested individuals with ADHD, both treated and untreated, with a PET scan of the brain and 18F-DOPA, a drug related to dopamine. Then, the brain images that resulted were statistically mapped.

"The most affected seemed to be the dopaminergic system. Until now, most studies focused on the so-called postsynaptic or receiving part of this system," said Mottaghy. "Our study shows that the beneficial effect of methylphenidate is received via 'normalization' of the dopamine system."

Results of the study were to be presented at this week's annual meeting of the Society of Nuclear Medicine, in San Diego.

"We demonstrated that the brain's dopamine system -- including midbrain, the striatum and the amygdala -- is differentially modulated in treated and untreated ADHD patients with respect to healthy normal controls," Mottaghy said.

More information

To learn more, visit CHADD and ADHD .

ADHD Drug to Get Stronger Warning

(HealthDay News) -- U.S. officials have asked a pharmaceutical company to add a label warning of a risk for heart problems for patients taking the prescription drug Dexedrine, a stimulant used to treat attention-deficit hyperactivity disorder (ADHD).

The warning describes some instances of sudden death in children and teens with structural cardiac abnormalities or other heart problems. It also mentions various potential psychological side effects, including hallucinations or delusional thinking.

The U.S. Food and Drug Administration could not be reached for comment, and it was unclear what other ADHD drugs might be affected by this new warning.

Back in May, the FDA had asked makers of similar stimulant ADHD drugs to add the warnings.
"This had already been done with other stimulants," said Dr. Melvin Oatis, an assistant professor of clinical psychiatry at New York University School of Medicine's Child Study Center.

"Dexedrine is in an older class of stimulant,s and not much new had been done with that."
A letter sent from Dexedrine's maker, GlaxoSmithKline, to health-care providers was posted Tuesday on the FDA's Web site. The letter detailed the planned changes to prescription recommendations.

In March, an FDA pediatric advisory committee had recommended that ADHD drugs not carry the more severe "black-box" warnings and instead use simpler language and include more information on the labels about the heart risks posed by the drugs. But the month before, a different FDA advisory committee had reached the opposite conclusion, and called for a black-box warning on ADHD drugs because of possible cardiac risks.

The FDA has apparently settled for the less-severe advisory.

"This is not a black-box warning," Oatis said. "There's some association [between Dexedrine and heart problems]. They're not making this a causality."

An estimated 2.5 million American children under the age of 19 take ADHD drugs, as do 1.5 million adults.

This represents a huge surge in use, experts said.

"ADHD is being recognized more often than it was before," said Dr. Eugenio Rothe, an associate professor of psychiatry at the University of Miami Miller School of Medicine, and director of the child and adolescent psychiatry clinic at Jackson Memorial Hospital. "When the disorder is being recognized more often, obviously there's more use of medication," he said.

In addition to "serious" cardiovascular side effects, the warnings issued since last spring cite possible suppression of children's growth, as well as heightened risks for psychosis, bipolar illness and aggression.

The revisions may have an effect on prescribing patterns, Rothe said.

"On the one hand, it may actually help pediatricians and even some psychiatrists be more careful," Rothe said. "But, on the other hand, it scares people away from getting treatment and also increases the amount of time that one has to spend with parents trying to convince them this is the right thing to do. Doctors are already stretched thin."

Oatis added that the new warning "should remind clinicians to review the side-effect profiles of medications. It reminds you to take more of a history of family issues regarding stimulant use and medical cardiac risk."

According to the U.S. National Institutes of Health, ADHD is a disorder characterized by inattention, hyperactivity and impulsivity. These symptoms typically appear early in a child's life. However, many healthy children may have these symptoms, but only at a low level, or the symptoms may be caused by another disorder. For that reason, many experts believe it is important the child receive a thorough examination and appropriate diagnosis by a qualified professional.

More information
The National Institute of Mental Health has more on ADHD.

ADHD Raises Kids' Health Costs Even Before Diagnosis

(HealthDay News) -- In the two years before and after they're diagnosed with attention-deficit hyperactivity disorder (ADHD), children with the condition typically use more health-care services than other children, U.S. research shows.

It also found that white children with ADHD accumulate more expenses than other children with the disorder.

Researchers in California analyzed health-care costs for more than 3,100 children, aged 2 to 10, who were diagnosed with ADHD between 1996 and 2004. They then compared those expenditures to health-care costs for more than 15,000 children without ADHD.

Compared to children without ADHD, those with the condition had average health care costs that were $488 higher in the second year before their diagnosis, $678 higher in the year before diagnosis, $1,328 higher in the year following diagnosis, and $1,040 higher in the second year after diagnosis.

Compared with white children with ADHD, Asian, black and Hispanic children showed lower annual costs for ADHD medications. Overall spending on ADHD services for Asian children was 30 percent lower ($221) than for white children, the study found.

The study was published in the October issue of the Archives of Pediatrics & Adolescent Medicine.

"Parents commonly state that behavioral problems predate their child's ADHD diagnosis, often by several years, and these problems may affect their use of health services," said a team led by G. Thomas Ray of the Kaiser Permanente Medical Care Program in Oakland.

"In our study sample, costs were significantly higher in the two years before the index date among children subsequently diagnosed with ADHD, and costs remained higher for at least two years following the initial ADHD diagnosis," the researchers noted. "Much of the excess cost was due to increased pediatric and psychiatric services, which were higher in the first year after diagnosis than in the second year."

Cultural acceptance of ADHD diagnosis and treatment could explain ethnic differences in costs and use of ADHD medications, the study authors said.

More information
The U.S. National Institute of Mental Health has more about ADHD.