A new study has found that children and adolescents taking a high
dose of antipsychotics are almost twice as likely to die of any cause
than children on other types of medications. Perhaps even more striking,
children taking high doses of antipsychotics were more than four times
as likely to die of cardiovascular or metabolic causes than children on
other medications.
The study, published online in JAMA Psychiatry, was led by
Wayne A. Ray, PhD, at the Vanderbilt University School of Medicine. The
data was captured between 1999 and 2014. The researchers included youths
between the ages of 5 and 24 years old, who were recipients of Medicaid
insurance in Tennessee. This allowed the researchers to examine their
medical records. In total, there were about 250,000 individuals in the
study. The researchers excluded children with severe physical illness
diagnoses, tic disorders, and schizophrenia. The most common included
diagnosis was ADHD. Photo Credit: Public DomainThe study was composed of three groups: a control group who were on
medications such as stimulants or antidepressants; a group who were
prescribed a low dose of an antipsychotic, and a group prescribed a high
dose of an antipsychotic.
The group taking a low dose of antipsychotics did not have a
significantly increased risk of death when compared to the group taking
other medications. However, children taking a high dose of
antipsychotics were 1.8 times more likely to die of any cause, 3.5 times
more likely to die of unexpected causes (not including overdose), and
4.29 times more likely to die of cardiovascular or metabolic problems.
Deaths from suicide were no different between groups.
In total, there were 40 deaths out of the 27,354 in the higher-dose
group (0.15%), compared to 67 deaths out of the 123,005 in the control
group (0.05%).
Of course, there could be other confounding factors that led to this
effect—something present in the higher-dose group that was not present
in the control group. However, the researchers controlled for the most
obvious explanations (diagnosis, medical illness, and any medication
use). Additionally, after the researchers ran a sensitivity analysis,
they concluded that “to explain the risk of unexpected death in the
higher-dose group, the confounder would have to increase risk by 5-fold,
have a 75% prevalence in the higher-dose antipsychotic treatment group,
and not be present in control patients.”
The potentially deadly cardiovascular and metabolic adverse effects
of antipsychotic medications are well-documented, but according to the
researchers, this is one of the first large studies to examine whether
children are at a greater risk of death due to these causes. The
researchers write that after the second generation of antipsychotic
medications was invented, these drugs began to be prescribed in younger
patients for all variety of indications, such as ADHD, depression, and
behavioral control—indications for which other, safer therapies might be
a better option. According to the authors,
“The study findings appear to reinforce existing
guidelines for improving the outcomes of antipsychotic therapy in
children and youths. These guidelines include restriction to indications
for which there is good evidence of efficacy, an adequate trial of
alternatives including psychosocial interventions when possible,
cardiometabolic assessment before treatment and monitoring after
treatment, and limiting therapy to the lowest dose and shortest duration
possible.”
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Ray, W. A., Stein, M., Murray, K. T., Fuchs, C., Patrick, S. W.,
Daugherty, J. . . . Cooper, W. O. (2018). Association of antipsychotic
treatment with risk of unexpected death among children and youths. JAMA Psychiatry. Published online ahead of print Dec. 12, 2018. doi:10.1001/jamapsychiatry.2018.3421 (Link)
MIA-UMB News Team: Peter
Simons comes from a background in the humanities where he studied
English, philosophy, and art. Now working on his PhD in Counseling
Psychology, his recent research has focused on conflicts of interest in
the psychopharmaceutical research literature, the use of antipsychotic
medications in the treatment of depression, and the general
philosophical and sociopolitical implications of psychiatric taxonomy in
diagnosis and treatment.
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