Doctors are putting more than 1000 additional Australian children per year on sedating antipsychotic drugs that can cause obesity, diabetes, brain impairments and movement disorders, “very concerning” federal government figures show.
Australia’s peak healthcare safety body has revealed it is investigating “inappropriate” prescribing to children of the controversial medications, warning they “can cause long-term harm, even at low doses”.
Federal health department data provided to news.com.au show the number of children aged 17 or under prescribed antipsychotics increased by 24 per cent between 2013-14 and 2017-18, far outstripping the age group’s 5 per cent population growth.
The prescribing hike means an estimated 24,700 Australian children were given the drugs in 2017-18, according to analysis of the data and numbers from the Australian Commission on Safety and Quality in Health Care by news.com.au.
Experts are concerned the high-risk drugs, traditionally reserved for severe psychosis, are being used to manage common childhood behavioural problems, particularly “disruptive behaviour” presentations they say should be addressed with non-medication therapies or less-risky pills.
Stress, insomnia, anxiety, depression, attention deficit-hyperactivity disorder and mild to moderate autism are also among the unapproved or inappropriate uses, senior clinicians and studies suggest.
Sydney University drug-use expert Emily Karanges said the “substantial growth (in numbers) over a short period” was “very concerning … especially when we know that these drugs are already overused or used inappropriately”.
“It suggests we are using antipsychotics much more freely, in milder cases of illness … and that we are becoming more blasé about the potential risks,” she said.
Antipsychotics frequently cause sedation, obesity and metabolic changes that can lead to diabetes and heart disease, while less frequent adverse effects include brain impairments that create movement disorders such as facial tics or a shuffling walk.
Still-debated research findings have also linked the drugs to brain shrinkage, prompting three psychiatrists to recently issue a warning in the Australian and New Zealand Journal of Psychiatry that children’s developing brains could undergo long-lasting adverse impacts.
An age breakdown released under freedom of information laws in 2016 showed more than 1300 kids taking the drugs were aged between just two and six, while more than 6000 were seven to 11-year-olds.
University of Queensland senior lecturer in psychiatry Peter Parry, who co-authored the warning paper, said most children on antipsychotics were “basically having their disruptive behaviour sedated” at the “risk of serious side effects”.
Antipsychotics had a place for children with a true psychotic illness, severe autism or “sometimes in rare cases of obsessive compulsive disorder … with pause for thought about the risk/benefit ratio”, but the cost was too high when used with other kids to manage their disruptive or aggressive behaviour.
Dr Parry said possible scenarios where youngsters were being given the drugs included behaviours linked to problems at school, family stresses such as financial problems and attention deficit and learning issues, while another issue was foster children being prescribed antipsychotics owing to issues stemming from maltreatment or abuse.
“But there are other medications and other non-medication interventions that are more appropriate … (including) family therapy, parent training programs, individual therapy with children and special educational assistance,” he said.
Australian Commission on Safety and Quality in Health Care chief medical officer Robert Herkes said antipsychotics “can cause long-term harm, even at low doses”, and that their use for non-approved indications “such as acute sedation in the absence of psychotic symptoms, is a particular concern”.
The commission is working on an “analysis … to understand the reasons for inappropriate prescription rates of antipsychotic medication in children”, which will be available next year.
Dr Karanges said causes of the increase in use included a “continuation of trends that have been occurring in psychiatry for decades — diagnosis of illness at lower thresholds, more ready use of medication, a greater reliance on drugs”.
There was also a “genuine increase in psychological distress in young people” — thought to be due in part to social media pressures — “that plays into our idea that we should quickly treat that distress (medically)”.
People had a widespread belief in a medicalised explanation of mental illness as a “chemical imbalance”, though this was “not well supported” by the research evidence, and were less willing to endure normal mental difficulties, such as those of adolescence.
Adelaide University professor of psychiatry and paediatrics Jon Jureidini said antipsychotics were being pushed “as broad spectrum psychiatric drugs”, despite being “dangerous”.
“The main problem is promotion of these drugs off label (for unapproved uses), managed by pharma (the pharmaceutical industry), but enacted, sadly, by my colleagues,” he said.
Paul Robertson, chair of the Royal Australian and New Zealand College of Psychiatry’s faculty of child and adolescent psychiatry, has stated doctors are pushed towards drug-prescribing by lack of access to non-drug mental health treatments. These are typically more expensive.
The class of antipsychotics include risperidone (often sold as Risperdal), quetiapene (sold as Seroquel, among others) and olanzapine (Zyprexa, among others).
Antipsychotic use in under-18s has official approval in schizophrenia, bipolar I disorder, severe behavioural disturbances in autism and certain subcategories of extreme disruptive behaviour conditions.
Experts emphasise that particularly in these conditions antipsychotics can be a crucial treatment, and they warn that stopping these medications, especially suddenly or without medical advice, can prove dangerous.
Continue the conversation @JoelMagarey