Pharmaceutical Research

More antipsychotic medications are being prescribed for youth and nursing home residents, despite lack of evidence

Antipsychotic medications are commonly being prescribed for children, adolescents, and nursing home residents for a variety of conditions not originally intended, despite a dearth of good evidence to warrant their use. The widespread use is due to the availability of newer agents called "atypical antipsychotics."

According to researchers from the Center for Education and Research on Therapeutics (CERT) at Rutgers University, atypical antipsychotics are considered safer than older agents and have all but replaced them. They have also become the most costly drug class for Medicaid programs, far surpassing antidepressants. For Medicare, they are a major expenditure item for the Part D drug program.

Most troubling is atypical antipsychotic use in children and adolescents, where prescriptions have increased fivefold. Currently, the U.S. Food and Drug Administration (FDA) approves their use to treat schizophrenia, autism, Tourette's disorder, and bipolar episodes. However, more than three-quarters of Medicaid youth are treated for non-FDA-approved conditions; the proportion is more than 70 percent for youth with private insurance. Such conditions include attention deficit-hyperactivity disorder and aggressive behavior, conditions for which little evidence exists to validate antipsychotic use.

A major concern is the side effect of significant weight gain, which may result in obesity, type 2 diabetes, and other problems. Also, nearly 28 percent of nursing home residents took antipsychotics in 2006, mostly to manage behavioral symptoms of dementia, such as agitation, irritability, and aggression. This was despite an FDA warning in 2005 that antipsychotic use is associated with an increased risk for death. Schizophrenia and bipolar disorder, FDA-approved conditions for antipsychotics, accounted for only 20.7 percent of resident antipsychotic use.

The findings were based on several market, State, and national databases. The study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS16097) to the Rutgers University CERT. For more information on the CERTs program, please visit http://www.certs.hhs.gov.

See "Broadened use of atypical antipsychotics: Safety, effectiveness, and policy challenges," by Stephen Crystal, Ph.D., Mark Olfson, M.D., M.P.H., Cecilia Huang, Ph.D., and others, in the July 2009 Health Affairs 28(5), pp. w770-w781.

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