Young adults and adolescents have been prescribed increasing amounts of antipsychotic medications, according to a study in JAMA Psychiatry.

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Age-related behavior was being targeted with drugs designed for psychotic conditions.

Children aged 13-18 years were given more of the drugs between the years 2006 and 2010, but not children younger than 12 years.

These prescriptions were for treatments licensed for mental conditions involving psychosis - but most office visits by the age group did not include one of these clinical diagnoses.

Clinical trials support the efficacy of several antipsychotics for child and adolescent bipolar mania, adolescent schizophrenia and irritability associated with autism.

Dr. Mark Olfson, of Columbia University, New York, and coauthors say:

"Age and sex antipsychotic use patterns suggest that much of the antipsychotic treatment of children and younger adolescents targets age-limited behavioral problems."

Youth are more susceptible than adults to the adverse effects of antipsychotics and the increasing off-label prescribing is "worrisome," says an editorial article accompanying the article in the same issue of the journal.

Acute and long-term side effects include weight gain and lipid and glucose abnormalities, say Dr. Christoph Correll of the North Shore-Long Island Jewish Health System, Glen Oaks, NY, and Joseph Blader, PhD, of the University of Texas Health Science Center at San Antonio. They conclude:

"As a field we must accurately identify youth for whom antipsychotic treatment is truly necessary by first exhausting lower-risk interventions for youth without psychosis.

Finally, when required, antipsychotic therapy should be as brief as possible and closely monitored."

The authors of the study conclude:

"In older teenagers and young adults, a developmental period of high risk for the onset of psychotic disorders, antipsychotic use increased between 2006 and 2010.

"Clinical policy makers have opportunities to promote improved quality and safety of antipsychotic medication use in young people through expanded use of quality measures, physician education, telephone- and Internet-based child and adolescent psychiatry consultation models and improved access to alternative, evidence-based psychosocial treatments."

Prescription data

To reach their findings the researchers analyzed antipsychotic prescription data from a database representing nearly two thirds of retail pharmacies in the US.

Nationwide in 2010, there were about:

  • 270,000 antipsychotic prescriptions dispensed to younger children
  • 2.1 million to older children
  • 2.8 million to adolescents
  • 1.8 million to young adults.

The percentages of young people using antipsychotics in 2006 and 2010, respectively, were:

  • For younger children between 1 and 6 - 0.14% down to 0.11%
  • For older children between 7 and 12 - 0.85% down to 0.80%
  • For adolescents between 13 and 18 - 1.10% up to 1.19%
  • Young adults between 19 and 24 - 0.69% up to 0.84%.

Among young people with claims for mental disorders in 2009 who were treated with antipsychotics, the most common diagnoses were attention-deficit/hyperactivity disorder in younger children (52.5%), older children (60.1%) and adolescents (34.9%) and depression in young adults (34.5%).