Antipsychotics triple risk of diabetes in kids, young adults

CLEVELAND, Ohio-- Antipsychotic drugs increased the risk of diabetes in children and young adults according to a recent study in the journal JAMA Psychiatry by researchers at Vanderbilt University.

Children who took the drugs—whose brand names include Risperdal, Seroquel, Abilify and Zyprexa—had a three-fold increased risk of Type 2 diabetes compared to children with the same conditions who took other medications.

The study group included 28,858 children in the Tennessee Medicaid program who had recently started antipsychotic medication. They were compared to more than 14,000 children who had similar diagnoses but were treated with other medications, including mood stabilizers (such as lithium, Depakote, Tegretol and Trileptal), antidepressants (such as Paxil, Zoloft, and Elavil), stimulants (such as Ritalin and Adderall), and drugs like Clonidine and Xanax.

The researchers tracked the kids and young adults, who were between 6 and 24 years old, for 12 years. The increased risk occurred within the first year of starting the antipsychotic medication, rose with cumulative doses, and persisted for up to a year after the children stopped taking the drugs.

The children were prescribed the drugs for conditions such as bipolar disorder, autism or behavioral problems, for which there were other medications available. Kids who had a diagnosis such as psychosis or schizophrenia, for which antipsychotics are considered the only effective treatment, were excluded from the study.

“What we’ve noted is that particularly for children there’s a lot of use [of antipsychotics] for what you’d call behavioral disorders, and that use has skyrocketed over the past 15 years,” said Wayne Ray, senior author of the paper.

“That led us to ask the question of how safe these drugs are.”

The study’s results were no surprise to Dr. Mackenzie Varkula, child and adolescent psychiatrist at the Cleveland Clinic’s Fairview Hospital and Dr. Molly McVoy, Program Director of Child and Adolescent Psychiatry at University Hospitals Case Medical Center.

“We’ve seen this clinically for a long time and have been waiting for the research to make its way through,” Varkula said.

The doctors said they see children who gain weight almost immediately—up to five pounds in the first week-- when they start taking antipsychotic medications.

“Those are the kids that we’re watching very closely,” McVoy said, monitoring for blood sugar and other changes that may indicate an increased risk of diabetes.

The current study adds to an increasing body of evidence linking the medications to diabetes, rapid weight gain, obesity and insulin resistance. Most of the research has been in adults, however.

Studies like the one at Vanderbilt cannot determine if the drugs cause diabetes. Butprevious research has shown that the weight gain associated with their use likely plays a role, as does an influence on the way the body reacts to insulin.

Doctors have been prescribing the drugs to children at a rapidly-increasing rate since they became available in the 1990s. Last year a study found that the number of antipsychotics prescribed to children and teens in the U.S. has quadrupled since they became available, and they are now prescribed in approximately the same proportion to children and teens as they are to adults.

“I think we have a lot of doctors starting kids on these medications because it might be helpful,” Varkula said. “Part of the problem is that we don’t have a lot of research on kids.”

“I think there are quite a few kids taking these drugs appropriately,” for schizophrenia, bipolar and severe aggression, said Varkula, but, she added that the odds of severe mental illnesses like schizophrenia or psychosis, which require antipsychotics, emerging at such a young age are extremely low.

McVoy said despite the increase in prescribing, the absolute number of children taking the medications is still small. “Most of my kids are not on them,” she said.

Yet the Vanderbilt study, which compared kids taking the drugs to those using different medications for the same conditions, raises the question of whether they’re necessary or should be used only as a last resort. About 87 percent of the children in the study were taking the newer “atypical” antipsychotic drugs, which include the brand namesClozaril, Risperdal, Abilify, Geodon, Seroquel and Zyprexa.

All of the drugs in this class carry a “black box” warning from the Food and Drug Administration on their labels warning of the risk of high blood sugar and diabetes. The black box warning is the strongest safety action the FDA can take short of recalling a medication.

Ray, of Vanderbilt, recommends caution when prescribing an antipsychotic for a child.

“You should consider other alternatives first,” he said. “There are many other adverse effects of antipsychotics in children and adolescents, and in the children that we studied, there are other alternatives. If an antipsychotic is prescribed there needs to be close monitoring.”

Varkula said that parents should “ask specifically what the symptoms are the drugs will be treating, and what they should be looking for in terms of improvement and side effects they should report.”

“Make sure it’s really worth it,” she said.

Varkula and McVoy said that the current research won’t likely change the way they treat patients, but only because they’ve known about the potential risk for a while. McVoy said primary care doctors and pediatricians, who manage more patients and can’t follow research on antipsychotics as closely as psychiatrists, will likely benefit more from the knowledge.

“There are some patients where these medications have absolutely saved their lives, without exaggeration,” McVoy said. “This is why we need these kinds of long-term studies. We just don’t have great data.”

http://www.cleveland.com/healthfit/index.ssf/2013/08/antipsychotics_triple_risk_of.html

Graham