Rutgers researchers have found that the use of antipsychotic medications in young children has decreased, but doctors continue to prescribe these medications off-label for conditions not approved by the U.S. Food and Drug Administration (FDA), according to a recent study.
Antipsychotic medications are used mainly to manage psychosis, a mental condition that involves symptoms like hallucinations and delusions, according to the National Institute of Mental Health website. These medications are used to treat illnesses such as severe depression, post-traumatic stress disorder, obsessive-compulsive disorder and generalized anxiety disorder.
Lead author Greta Bushnell, assistant professor of epidemiology in the Department of Biostatistics and Epidemiology and member of the Rutgers Institute for Health, Health Care Policy and Aging Research, said the study was motivated by earlier research that described a concerning increase in antipsychotic use among young children.
“Declines had since been noted in children enrolled in Medicaid, (but) it was not known whether declines in antipsychotic use had also occurred in privately insured children and if declines had persisted into recent years,” she said.
The researchers aimed to answer those questions by examining trends in antipsychotic use among privately insured children, Bushnell said. They looked at 301,311 antipsychotic prescriptions completed by children ages 2 to 7 in the U.S. between 2007 and 2017, according to a press release.
Annual antipsychotic use peaked in 2009 before declining in the remaining years, according to the study. Bushnell said the reduced use of antipsychotic medication in young children was likely caused by multiple factors, such as increased healthcare provider education and changing prescription guidelines.
She said that while some medications carry FDA approvals for younger age groups, these guidelines still urge caution when prescribing them antipsychotic medications.
Guidelines recommend that psychosocial services be used before treatment with antipsychotics and that children receive careful assessment before starting this treatment, she said, according to the release.
“(But), fewer than half of the children receiving antipsychotic treatment in our study had a visit with a psychiatrist or a psychotherapy claim,” Bushnell said, according to the release.
Antipsychotics continue to be used off-label and are prescribed for different conditions, despite such usage lacking safety and effectiveness data, according to the release.
“Concerns arise when we lack evidence that the medication is effective in treating that population, such as antipsychotics for (attention deficit hyperactivity disorder) (ADHD) in young children and when there are potential safety concerns,” Bushnell said.
She said their study demonstrated that there has been a broad shift away from prescribing antipsychotic medications for young children with conditions that have not had an adequate amount of clinical support.
Bushnell said that even with conditions that have been approved for this use of medication, evidence of effectiveness and safety for young children is limited.
“By describing how these medications are being used in this young population, we can identify where more research is needed and where continued efforts are needed to improve treatment,” she said.