Antipsychotic use in Canadian children and teens is rising dramatically – prescriptions more than doubled in just 4 years, from 2005 to 2009.
That’s according to a paper just out from Pringsheim et al. It’s been known for a while that broadly the same is true of the USA. The data reveal that the Canadian border is no barrier to the spread of antipsychotics.
What’s surprising is that while in the USA, some of these drugs are officially licensed for use in certain children and adolescent psychiatric disorders, in Canada all such use is off-label. That didn’t stop there being nearly 700,000 youth prescriptions for an antipsychotic in 2009, in a country with a total population of 35 million – although bear in mind that this includes multiple prescriptions for the same person.
What’s disturbing about this, as I’ve said before, is not so much the fact that these drugs are being used but the speed of the growth. It represents a fundamental shift in the way children and adolescent mental health problems are treated, one which has happened so fast that it’s hard to believe that there was time to properly think through the consequences…
Use of SSRI antidepressants and psychostimulants (mainly ADHD drug methylphenidate, Ritalin) also rose between 05 and 09, but only by about 40%. That means that there were more antipsychotic than SSRI prescriptions in children and teens by 09, which is pretty remarkable.
Only 13% of the youth antipsychotic recommendations were actually for psychosis, the original indication of the drugs. The leading diagnosis was ADHD, which is odd, because the main drugs for ADHD, such as Ritalin, boost dopamine release, while antipsychotics block dopamine’s effects via D2 receptors.
Other popular indications were mood disorders and conduct disorders. Overall, the fact that the vast majority of the antipsychotic prescriptions were not for psychosis confirms the view that the term “antipsychotic” for these drugs is misleading.
Pringsheim T, Lam D, and Patten SB (2011). The Pharmacoepidemiology of Antipsychotic Medications for Canadian Children and Adolescents: 2005-2009. Journal of child and adolescent psychopharmacology PMID: 22136092