Antipsychotic Prescriptions in Children Have Skyrocketed

Time Magazine  There is much evidence that the vast increases in atypical antipsychotic prescribing in recent decades were fueled by the aggressive marketing tactics of drug companies. In recent years, every major manufacturer of atypical antipsychotics has been involved in the illegal marketing of the drugs (while doctors can prescribe drugs off label, it is against the law for drug makers to market them for off-label uses), each ultimately paying hundreds of millions to billions of dollars in fines for their sales and marketing tactics. The settlements with the U.S. government were among the largest in history.

The new study, published in the Archives of General Psychiatry, found that in 2005-09 nearly two thirds of all antipsychotic prescriptions for youth were written for ADHD and other disruptive behavior disorders; these conditions accounted for 34% of all antipsychotic prescriptions for teens. Yet there is little data supporting the safety or efficacy of the drugs for those conditions. The drugs’ effect on children’s brain development is also not known, but their side effect profile is clear: aytpical antipsychotics are known to cause weight gain and diabetes, side effects to which children seem particularly prone.

“As the actual evidence base that would support [such off-label prescriptions of antipsychotics] is scant to non-existent, and the evidence of permeating undue influence of pharma on prescribing practices in psychiatry is abundant, one is led to the conclusion that this is another example of irrational prescribing that can be traced to both the overt and tacit influence of [drug companies] on practitioners,” says Dr. Bruce Perry, a senior fellow at the ChildTrauma Academy. [Full disclosure: Perry and I have co-authored two books.]

Perry testified for the state of Texas in a case that resulted in a $158 million settlement with Johnson and Johnson in January to resolve claims that it fraudulently marketed Risperdal and swindled the state’s Medicaid program. One aspect of the case involved misleading claims about the drug’s effectiveness for behavior disorders in children.