More on Adverse Effects of Antipsychotics on Children

An observational study details metabolic changes after 12 weeks of treatment with atypical antipsychotics.

During the past decade, pediatric prescriptions of atypical antipsychotics (AAs) increased fivefold, and more than 80% were for nonpsychotic diagnoses (JW Psychiatry Jun 23 2008, Jun 21 2006, and Sep 4 2002), notwithstanding reports of extreme weight gain at young ages (JW Psychiatry Apr 10 2002). These researchers evaluated the effect of AA use in 272 AA-naive patients from clinical settings (age range, 4–19 years; mean age, 14) who were prescribed olanzapine, risperidone, quetiapine, or aripiprazole; controls were 15 enrollees who refused treatment or became noncompliant.

In this open, nonrandomized, 12-week study, the investigators measured weight, height, body-mass index, lipid and glucose levels, insulin resistance, fat mass, and waist circumference at baseline and after AA exposure. Diagnoses included schizophrenia, affective disorders, and aggression. Treating physicians could change dosing and prescribe other medications.

At a median of 11 weeks, mean weight gain was significant in medicated patients (4.4–8.5 kg) but not in controls (0.2 kg). All AAs except aripiprazole were associated with lipid level abnormalities. Weight gain of 7% or more of baseline weight occurred in most medicated patients (range: quetiapine, 56% of patients; olanzapine, 84%).

Comment: These data are consistent with reports of gravely harmful and pervasive adverse effects of AAs on children's development. Common sense should point clinicians to consultations on nutrition and exercise. Children on AAs, however, often present with voracious appetites that are unlikely to be amenable to dietary measures. A few studies (e.g., JW Psychiatry Jan 12 2007) have shown promising results with metformin, which might help some children. Neither metformin for AA-induced weight gain nor AAs for many child psychiatric disorders are FDA-approved indications. Pediatricians and family physicians should carefully consider obtaining child psychiatry consultations before prescribing AAs. Clinicians need to carefully consider both nondrug and non-AA first-line interventions for childhood nonpsychotic disorders.