Worried about the risk of atypical antipsychotics for your child? Homeopathic Medicine offers a safer alternative

Townsend Letter for Doctors and Patients,  Oct, 2006  by Robert Ullman,  Judyth Reichenberg-Ullman

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Two recent articles (USA Today. May 2, 2006; Archives of Psychiatry. June 2006) have set off a flurry of discussion about the off-label prescribing of antipsychotic drugs to children. These drugs include Risperdal (risperidone), Zyprexa (olanzapine), Abilify (aripriprazole), Clozaril (clozapine), Seroquel (quetiapine), and Geodon (ziprasidone).

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According to M. Olfson et al. in the Archives of Psychiatry article abstract:

  ... the estimated number of office visits by children and adolescents
  (younger than 21) that included antipsychotic medications increased
  about sixfold, from 201,000 in 1993 to 1,224,000 in 2002. From 2000 to
  2002, 92% of visits that involved prescriptions for an antipsychotic
  included a second-generation (i.e., an atypical antipsychotic)
  medication ... The most frequent mental health diagnoses were
  disruptive behavior disorders (38%), mood disorders (32%), pervasive
  developmental disorders or mental retardation (17%), and psychotic
  disorders (14%). Among patients who were prescribed an antipsychotic,
  one-third were simultaneously prescribed an antidepressant and one-
  third were prescribed a mood stabilizer.... Second-generation
  antipsychotics are not without significant side effects, including
  weight gain, hyperlipidemia, and insulin resistance leading to
  diabetes mellitus. Adverse metabolic effects of some second-
  generation antipsychotics may be more severe in children and
  adolescents than in adults.... Their current widespread use calls for
  more controlled studies of second-generation antipsychotic medications
  in children and adolescents.

This increase in prescriptions and possible side effects parallels what we have observed in our own practice regarding children with diagnoses of ADHD, ODD, and bipolar disorder. We first began seeing prescriptions for Depakote and Tegretol (anticonvulsant medicines) for aggression, bipolar disorder, or other mood disorders. In the mid-to-late 1990s, we began to see an increasing number of prescriptions of Risperdal, Zyprexa, Geodon, and Clozaril. In our work thirty years ago in inpatient psychiatric units, antipsychotic medications were reserved for schizophrenics. Most recently, the newest atypical antipsychotic, Abilify, has begun to show up in the medication lists of our child patients. We have been increasingly concerned that many children with attention, behavior, and mood disorders are being given powerful drugs with considerable side effects that have not been tested on or approved for use in children.

The USA Today article was well balanced, including several stories, both positive and negative, of children who had experienced benefits or side effects of atypical antipsychotic medicines. One 15-year-old patient, Alexa, had stabilized her violence and mood swings on a mix of medicines, including an atypical antipsychotic, but unfortunately also gained 100 pounds in a year. Another patient, Rex Evans, 13, developed tardive dyskinesia, causing involuntary muscle movements and facial grimacing, after being treated with an atypical. This is a known side effect of these drugs considered more common in the older generation of antipsychotics, such as Haldol, Thorazine, and Mellaril.

One supposed success story reported by USA Today, was that of Camille Houston. Camille was quite bright as a young child, but suffered from dramatically alternating moods. ADHD, depression, and oppositional behavior. Treatment with Depakote and Prozac made her increasingly manic with hallucinations. During hospitalization, doctors gave her Risperdal, then later, Zyprexa, which was more effective at higher doses. Now a teenager, she takes an ADHD medication, Depakote, Welbutrin, and both antipsychotics, but is relatively stable, though her IQ has dropped 40 points since grade school. Her parents described her as "flourishing as an artist" of colorful, abstract painting and progressing in her special education classes. Camille describes herself as happy, with some friends. She says that sometimes she is able to forget that she has a disease, because of the certain knowledge of "who I am."

USA Today also sponsored its own surveys of atypical antipsychotic usage. An analysis of FDA data showed "at least 45 deaths of children from 2000 to 2004 where an atypical was considered the "primary suspect." The deaths were linked to conditions such as diabetes, heart and pulmonary problems, suicide, choking, and liver failure. More than 50% of these children were taking multiple drugs for psychiatric and other conditions.

Harmful side effects were reported in more than 1300 cases, some possibly life-threatening. Convulsions and low white blood cell counts were among the reported side effects. Other side effects included dystonia (involuntary and often painful muscle contractions), tremors, weight gain, sedation, and tardive dyskinesia. Neuroleptic malignant syndrome, with 41 cases reported in five years, is a life-threatening illness with fatal effects possible with some patients within 24-72 hours of diagnosis. It involves fever, rigidity, tremors, and cognitive changes such as confusion and stupor, even coma. Patients who survive can be left with Parkinsonism, ataxia, and dementia.