Dabbling in Prescription Danger

In the case of children, "the instances where it would be clinically appropriate to prescribe an anti-psychotic to a child are few and far between. I would speculate that, in many of those cases, the prescribing of those drugs is dubious.
"An unwitting physician prescribes an antipsychotic, and then a few days later sees the patient is agitated and thinks, 'I must need to increase the dose or add another drug.
Dr. David Juurlink, Internal medicine specialist, head of clinical pharmacology and toxicology, Sunnybrook Health Sciences Centre, Toronto

Drugs known as "second-generation" antipsychotics, explains Dr. Juurlink, may cause a range of neurological side effects, including acute dystonia, or sudden involuntary spasms of the muscles of the head and neck. And these symptoms can appear as soon as hours or days within starting treatment.

Yet another side effect induced by antipsycotics is akathisia, which can cause extreme restlessness, fidgeting, rocking while sitting or standing or marching on the spot.

Considering that these drugs are prescribed by well-meaning general practitioners in response to concerns from parents of children who are hyper-active, whose behaviour they feel needs to be modified because it concerns them, since they believe their perpetual-motion children are behaving in an unnatural manner, the side-effects of the second-generation antipsychotics is rather neurologically telling.

And Dr. Juurlink describes more than adequately a trajectory of events, where the drug induces actions as a result of neurological responses to the chemicals, convincing the doctor that an increased dose seems required. That increased dose further exacerbating the situation, and creating in its fallout a serious medical situation that the doctor has little real idea how to deal with.

The SGAs, according to Dr. Juurlink, have an appropriate use where some success is realized; in the treatment of young people over age 15 who are diagnosed with schizophrenia and related mental disorders. And it is medically inexcusable that the pills are being increasingly given to children for attention deficit/hyperactivity disorders, "conduct" disorders, "frustration intolerance", and even to cure insomnia.

"To use them for sleep borders on malpractise", he says unequivocally. Yet, in Canada, drug use for children is accelerating. In 2007, 12% of all SGA prescriptions were written up for children, and most for problems seen to have a behavioral basis. "We're seeing an increase in these disorders, we're seeing an increase in kids who are not functioning", Dr. Diane Sacks, assistant professor of pediatrics, University of Toronto, says.

Parents are not being adequately warned of the possible dangers inherent in the use of these drugs. The possible side effects that include sudden and dramatic weight gain, diabetes onset, and a 30-times higher risk of metabolic syndrome, representing a cluster of conditions increasing risk of heart disease and stroke.

These are not theoretical in nature; Health Canada received 17 reports of fatalities in children, related to the use of SGAs.

"The big issue is, are the medications (antipsychotics) that are being prescribed used in the right way or not? That's a huge question. And the answer is, we don't know, because the studies haven't been done", says Dr. Stanley Kutcher, Sun Life Financial chair in adolescent mental health at Dalhousie University in Halifax.

Well then, are the medications being prescribed in the right way? They are not meant for use by children. Yet prescriptions are being given to parents by general practitioners to treat their children as young as pre-schoolers. One prescription antipsychotic drug only is advised for use by children - 15 to 17 years of age and for a specific condition.

Does it need a study to point out the inappropriateness of prescribing powerful antipsychotics to toddlers?