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Why Are Boys Getting Prescribed So Many Antipsychotic Drugs?

Should that boy who can't stop fidgeting in class be on antipsychotic drugs? How about the middle school boys who keep getting into fights? How about the kindergartener who won't stay criss-cross applesauce?

In a pretty troubling study, the National Institutes of Mental Health find stark sex differences and gaps in mental health diagnoses in the prescription of antipsychotic drugs, even for very young children.

Boys at any age are likelier than girls to be given antipsychotic medicines, such as Risperdal and clozapine, according to the study, published online Thursday in the journal JAMA Psychiatry. NIMH researchers studied more than 765,000 prescriptions in 2006, more than 858,000 in 2008, and more than 851,000 in 2010, all for patients ages 1 to 24.

They found in 2010, doctors nationwide prescribed about 270,000 antipsychotic medicines to children under 6, 2.14 million to children ages 7 to 12, 2.80 million to adolescents ages 13 to 18, and 1.83 million to young adults ages 18 to 24. Those rates were up for adolescents and young adults since 2006 (peaking in 2008) but level for younger children.

As the chart below shows, the percentage of the boys and girls on antipsychotics rises during school years, with sex-based gaps closing in the years after high school:

psychodrugs.JPG


ADHD, Not Schizophrenia, Drives Drug Prescriptions for Kids

So are mental health disorders more likely to be identified in the school years? Yes, but that doesn't seem to be what's going on here. Far fewer than half of the children and adolescents prescribed the medicines had been diagnosed with a mental health disorder.

While the U.S. Food and Drug Administration has approved antipsychotics for children and adolescents with conditions like bipolar disorder, schizophrenia, and autism, those conditions weren't the ones driving prescriptions. For those who did have a diagnosis, attention-deficit hyperactivity disorder was the most common by far for school age children—accounting for 50 to 60 percent of diagnoses for children under 12, and more than a third of those for adolescents. For young adults, by contrast, depression and bipolar disorders accounted for the most prescriptions.

"Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms," the researchers conclude.

To put it more simply: We may be overmedicating boys for being appropriately active for their age, using drugs whose longterm effects we don't yet know when given to young children.

In an editorial accompanying the study, editors noted that antipsychotics are often prescribed to younger people off-label, for uses not yet approved by the FDA. In the editorial, researchers also noted that separate studies have found extended use of these drugs can lead to lower brain volume and neuron density. Those studies have been on adults; not much is yet known about how such drugs affect children whose brains are still developing.

"Antipsychotics should be prescribed with care," said NIMH researcher and co-author Michael Schoenbaum in a statement on the study. "They can adversely affect both physical and neurological function and some of their adverse effects can persist even after the medication is stopped."  

Chart: As of 2010, about 1.5 percent of boys ages 10 to 18 received an antipsychotic prescription. Sex-related gaps in prescribing open up as children get older, but close again as they reach young adulthood. Source: "Treatment of Young People With Antipsychotic Medications in the United States."


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