Doctors’ Group Cautions Antipsychotic Misuse and Overuse

Some key psychiatrists are warning that antipsychotic medications should not be the first line of defense in certain groups for specific disorders.

Dementia in the elderly, pediatric behavioral issues, and adult insomnia should not be treated with antipsychotics. according to a statement released by the American Psychiatric Association’s (APA) new list of questionable antipsychotic uses, according to USA Today. The statement is part of a campaign entitled “Choosing Wisely,” which is intended to teach parents and physicians about unnecessary and potentially dangerous treatments and tests. To date, 50 medical groups have provided lists of common practices that the medical community and patients should question, such as overuse of colonoscopies and prescribing antibiotics for the common cold, a condition for which antibiotics have no use.

This list focuses on the controversial potential misuse of antipsychotic medications, including older generation antipsychotics long used for conditions such as schizophrenia and bi-polar disorder. Newer, or so-called atypical antipsychotics, are broadly used to treat difficult nursing home patients, children with aggressive behaviors, or children with attention deficit hyperactivity disorder (ADHD), even though concern has mounted over the drugs’ side effects, according to USA Today. Medications include the brands Risperdal, Zyprexa, Seroquel, and Abilify.

Doctors “are doing what they think might help,” but typically without trying safer, more efficacious options, said Joel Yager, a psychiatry professor at the University of Colorado-Boulder, and one of the developer’s of the new list. The group also warns that the drugs should not be used without full evaluations or routine monitoring and the drugs should not be used in combinations of two or more without first trying several single medication options first, according to USA Today. The group also said using the drugs as a first choice treatment of the following is questionable:

• Dementia’s behavioral and psychological symptoms. Side effects may include confusion, sedation, and premature death.
• Children and teenagers with non-psychotic disorder diagnoses. Side effects include weight gain, cardiovascular changes, and increased risks for type 2 diabetes.
• Adult insomnia. The group says there is no sufficient evidence the drugs work for insomnia.

We’ve written that research has found that use of antipsychotic drugs such Seroquel, Abilify, and Risperdal has been found to triple a child’s risk of developing Type 2 diabetes in just the first year of use. In recent years, antipsychotic prescriptions have increased a massive seven-fold in children and almost five-fold tor teenagers and young adults aged 14 to 20, according to a 2012 study from Columbia University, wrote HealthDay News previously.

Federal health officials have launched a probe into the use of antipsychotic drugs, such as Risperdal and Zyprexa, on children who are in the Medicaid system. Concerns have been raised that these drugs are being prescribed far too often to treat young children diagnosed with behavioral problems. Other research has found that some antipsychotic drugs are associated with increased risks for developing torsade de pointes (TdP), a type of abnormal heart rhythm, and other adverse events. Zyprexa was among the drugs studied.

In addition to diabetes, longer-tem antipsychotic risks may also include major metabolic syndrome and a neurological disorder that causes tardive dysinesia (involuntary, repetitive movements).