Antipsychotics Increasingly Prescribed To Patients Without Mental Illness

We’ve long written about antipsychotics prescribed, off-label, for an array of reasons. Sadly, there is a trend of prescribing the potent medications, such as Seroquel, Zyprexa, Risperdal, and Abilify, to patients with no history of mental illness.

Adriane Fugh-Berman, a physician and associate professor of pharmacology at Georgetown University, described two graduate students who had no symptoms of mental illness, but who were prescribed powerful schizophrenia drugs for the treatment of insomnia, said The Washington Post. “It’s a total outrage,” said Fugh-Berman. “These kids needed some basic sleep [advice], like reducing their intake of caffeine and alcohol, not a highly sedating drug.”

Antipsychotics are approved for serious psychiatric conditions, such as schizophrenia and bipolar disorder; however, they are often used off-label to treat vulnerable populations, such as seniors with dementia—and most recently, Medicaid children. Although atypical antipsychotics’ use is on the rise for a range of off-label conditions, the drugs are only effective for a few such diagnoses. The drugs can also lead to sedation and can contribute to weight gain and diabetes. Drugs can be prescribed at physician discretion yet, these drugs, in particular, are being used to many disorders. Some uses have seen recent approval by the U.S. Food and Drug Administration (FDA); many have not.

Previously, noted The Washington Post, the 11 atypical antipsychotics—most approved in the 1990s—were only prescribed to about 3% of the American population who were diagnosed with the most serious mental illnesses. Today, antipsychotics are being used to treat serious depression, among other ailments, such as anxiety, attention deficit disorder, behavior issues in the very young and very old, and sleep issues.

New antipsychotics, today, actually comprise over 90% of the market, much more than their older generation counterparts. The Washington Post noted that a study, last year, found that off-label antipsychotic prescriptions more than doubled in recent years from 4.4 million in 1995 to 9 million in 2008. A Medco report—Medco is a pharmacy benefits manager—revealed that antipsychotic use in adults increased by a whopping 169% between 2001 and 2010, said The Washington Post.

“Antipsychotics are overused, overpriced and oversold,” said Allen Frances, former chair of psychiatry at Duke University School of Medicine, who headed the task force that wrote the DSM-IV, psychiatry’s go-to book on psychiatric diagnoses, noted The Washington Post. Although careful off-label antipsychotic use might be called for in, for instance, very severe obsessive-compulsive disorder, the drugs are being used “promiscuously, recklessly,” Frances added.

Wayne Blackmon, a psychiatrist and lawyer who teaches at George Washington University Law School, said has seen patients taking more than one antipsychotic and that, given their serious side effects, this raises risks for adverse reactions, according to The Washington Post. Said Blackmon, antipsychotics are the “drugs du jour,” being prescribed, more and more, for “problems of living. Somehow doctors have gotten it into their heads that this is an acceptable use,” he said.

Antipsychotics bear a black-box warning, the FDA’s strongest, since 2005, cautioning against prescribing the drugs to elderly dementia patients due to increased death risks. In 2008, the agency repeated a prior warning, stating that “antipsychotics are not indicated for the treatment of dementia-related psychosis.” Regardless, say experts, antipsychotic use in this vulnerable population is increasing, said The Washington Post, often to quiet difficult or agitated elderly patients.

As we’ve mentioned, antipsychotics are often prescribed to younger populations to control undesirable behaviors. Covered under Medicaid, children are diagnosed, for instance, with bipolar disorder (which is not traditionally diagnosed until after puberty) and prescribed antipsychotics as a form of sedation. “Sedation is the key reason these meds get used,” said Mark E. Helm, a Little Rock pediatrician who was a medical director of Arkansas’s Medicaid evidence-based prescription drug program from 2004 to 2010, said The Washington Post.

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