Last month, a hearing in the Vermont Legislature yielded information about how that state’s doctors prescribe antipsychotic drugs to children. About half the time, it seems, they don’t follow the recommended guidelines for those powerful drugs.
Such drugs sometimes are prescribed for children with bipolar disorder and schizophrenia, as well as other problems.
The hearing, as reported by AboutLawsuits.com, included testimony that although rates of antipsychotic prescriptions to children in that state are declining, Vermont doctors followed prescribing guidelines by the American Academy of Child and Adolescent Psychiatry (AACAP) only about half the time.
And the decline in use isn’t as significant as it should be. Dr. David C. Rettew, director of the Pediatric Psychiatry Clinic at University of Vermont’s College of Medicine, referred to a recent survey showing that despite FDA recommendations to give antipsychotics to minors even less often, doctors chose the less-is-more approach only about 1 in 4 times. There’s no reason to believe there’s anything about Vermont that would make it unusual in this regard.
Rettew said the biggest problem wasn’t overprescribing, but failing to review laboratory practices. “The main reason best practice guidelines were not followed,” he testified, “was much more related to a lack of lab work monitoring rather than prescribing these medications for mild problems or before other pharmacological and nonpharmacological treatments had been tried first.”
As we’ve reported, side effects of antipsychotic drugs can include weight gain and a greater risk of developing diabetes (Abilify). Male breast growth also has been correlated with some of these drugs (Risperdal), as have urinary problems (clozapine). No one should take them without trying other treatments first.
Rettew said that only 15 in 100 children received psychotherapy before being prescribed antipsychotic drugs, and that in many cases the current prescribing doctor wasn’t the provider who originally prescribed the drug, so there was a disconnect between the current doctor’s treatment and a patient’s treatment history.
The news from Vermont, AboutLawsuits recalled, follows an investigation from last year by the Department of Health and Human Services’ Office of the Inspector General (DHHS-OIG) about the use of antipsychotic drugs by recipients of Medicaid younger than 18.
Scrutiny has sharpened not only on the use of these drugs for FDA-approved disorders, but for “off-label” uses; that is, for problems for which they have not been approved by the FDA as safe and effective. Many people are concerned that instead of focusing on the causes of a child’s behavioral problems, doctors — and parents — seek to treat the symptoms, often first with drugs.