Mainstream Psychiatry Intensifies Criticism of Off-Label Antipsychotics for Children

by Edward Opton

The use of “antipsychotic” medications to suppress troublesome behavior in youths and children has had many critics, but it is news when such criticism comes from the center of the psychiatric profession

On July 1, 2015, an American Medical Association journal published a large-scale study of antipsychotic medications prescribed to children and youth,[1] and alongside it, a strongly worded editorial.[2] The editorial expresses serious concern about the “adverse effects” of antipsychotics—adverse effects that “may diminish brain volume and neuronal density.”

In ordinary English, “diminish brain volume” means “shrink the brain,” and “diminish . . . neuronal density” means “replace active brain cells with inert, non-functioning tissue.”

The impetus for the concern endorsed by JAMA Psychiatry is the widespread use of powerful antipsychotic drugs for “off label” purposes not approved by the FDA. The drugs are approved primarily for adults suffering from some of the most desperate mental diseases, such as schizophrenia. The editorial deplores use of antipsychotic drugs “hastily and for too long to suppress problematic behaviors . . . .”

The two new publications are significant for multiple reasons.

  1. The authors of the article and the editorial are distinguished members of the mainstream medical establishment. Mark Olfson, MD, is a professor of psychiatry at Columbia University; the research was supported by grants from the U.S. National Institutes of Health to Yale University and to Columbia University.
  1. The article and the editorial are published in one of the most mainstream and “establishment” of journals, JAMA [Journal of the American Medical Association]
  1. The results are based on a massive database: more than 750,000 children and more than 7 million prescriptions.

The facts are not a surprise. It is their appearance in the medical mainstream that is unusual and significant.

Implications

The JAMA Psychiatry article and editorial may signal that it is time for mainstream medicine to make a turnaround: time to limit the use of antipsychotics for children and adolescents to the small number of exceptionally serious conditions for which they are FDA-approved. For children and adolescents in foster care, federal and state government agencies have the authority to specify such limits and to enforce them. It is time to do so.

 

[1] Olfson, M., King, M., & Schoenbaum, M., Treatment of young people with antipsychotic medications in the United States. JAMA Psychiatry published online, July 1, 2015.

[2] Correll, C.U. & Blader, J.C., Antipsychotic use in youth without psychosis: a double- edged sword. JAMA Psychiatry published online, July 1, 2015.

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