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Antipsychotic Prescriptions to Children – Too Much Too Soon?

Following yesterday’s post on the issue of weight gain and metabolic syndrome seen in kids treated with second-generation antipsychotics (SGAs), today, I look at another paper by Silvia Alessi-Severini and colleagues from the University of Manitoba published in the same issue of the Canadian Journal of Psychiatry.

This paper examines the use of antipsychotics in children and adolescents (aged 18 years or younger) based on data collected from the administrative health databases of Manitoba Health and the Statistics Canada census between the fiscal years of 1999 and 2008.

Over these 10 years, prevalence of antipsychotic use increased with the introduction of the SGAs from 1.9 per 1000 in 1999 to 7.4 per 1000 in 2008.

The male-to-female antipsychotic usage ratio increased from 1.9 to 2.7 as the male youth population represented the fastest-growing subgroup of antipsychotic users in the entire population of Manitoba.

Notably, the paper finds that total number of prescriptions also increased significantly despite the lack of approved indications in this population.

More than 70% of antipsychotic prescriptions to children and adolescents were written by general practitioners with the most common diagnoses being attention-deficit hyperactivity disorder and conduct disorders. In fact, the use of antipsychotics in combination with methylphenidate (ritalin) increased from 13% to 43%.

Thus, it appears that there is extensive off-label use of SGAs in kids and youth in Manitoba (and likely in other provinces), a finding that is of concern not least because of the significant (30-fold increased) risk of weight gain and metabolic syndrome associated with the use of these compounds.

So, while there is no doubt that these drugs may provide important clinical benefits in kids who do need them, it is hard to imagine that this degree of off-lable prescription is indeed warranted.

Again, I would love to hear from my readers regarding experience with these medications in children and youth.

Ottawa, Ontario


  1. Well, that’s interesting. And by “interesting,” I mean “appalling.” I think we’ve got a major driver behind the “childhood obesity epidemic” there.

    Is it me, or are we increasing trying to drug children who don’t conform well to the most convenient learning style for the educational system? The human population does have quite a bit of diversity in learning and other aspects of mental functioning (as in body size). Increasingly, people who don’t conform to conventions are being labelled as diseased and in need of treatment. I don’t think that this is a good thing.

    This is reminding me of an old episode of “Twilight Zone.” (googling…) “Eye of the Beholder.”

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  2. This is a significant issue. Off label use in this vulnerable population, with little regard for the side effects, is becoming a significant health issue that people need to take seriously.

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  3. @DeeLeigh: Yes, appalling indeed. Well stated. Many of the great thinkers and artists of past generations would be labelled, if they lived as children nowadays, as learning disabled or mentally disordered–and promptly be “appropriately” medicated, with their unique creative energy and vision sucked right out of them. Too often we look for the origins of suffering (and the “treatments”) within individuals while failing to critically analyze the social structures and systems that construct suffering.

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