"Abilify," Harry shouted.

OK, first, I'm sorry about that ridiculous post title. But, ever since they introduced Abilify a few years back, I've thought that the name sounded like a spell from a Harry Potter novel.

Anyhoodle, today is apparently "NPR Medical Information Day" here at Bleakonomy. From the NPR health blog:
Antipsychotic drugs used in kids can carry a steep health cost. Many children gain an unhealthy amount of weight after just a few months on the medicines.

Research just published in JAMA found the drugs led to weight gains ranging from about 10 to 19 pounds, depending on the medicine, in about 11 weeks. The analysis looked at popular brand-name drugs Abilify, Risperdal, Seroquel and Zyprexa.

The findings confirm what doctors pretty much already knew about the medicines. So why bother? For one, to tell doctors exactly what they can expect to see. Doctors have been prescribing these drugs more and more to kids -- not just for schizophrenia and bipolar disease, but also for attention deficit disorder.

As the link (which is from June) in the above quote notes:
Last week, FDA staff members released reports saying the three drugs do help kids, but that there are serious side effects. They can cause sedation, heavy weight gain and other problems that can lead to heart disease and diabetes.

"If these children are starting these medications at very young ages, they're likely to be on them for many years," says Dr. William Cooper, a professor of pediatrics at Vanderbilt University School of Medicine. "So the adverse effects, such as weight gain, increased lipids, increased blood sugar are likely to have potentially long-term and important side effects for these children."

Cooper says bad outcomes may be worse in kids than they are in adults, and there needs to be more study of the side effects in children.

After seeing a lot of kids coming to his clinic who had been prescribed these expensive and heavily marketed medications designed for adults, Cooper did a national survey. He found that the number of prescriptions to children had increased five times over a recent seven-year period.

Over a similar period, another study found, the number of children diagnosed with bipolar disorder had increased 40 times. Still, Cooper says that doesn't explain all of the increase in the use of antipsychotics among children and adolescents.

Cooper says he was surprised that, in most cases in his survey, doctors weren't prescribing the drugs for serious mental illness. "Only one-third of the use was for bipolar or schizophrenia," says Cooper.

Instead, nearly 30 percent were prescribed to kids diagnosed with attention deficit hyperactivity disorder; nearly 15 percent went to children and adolescents with no psychiatric diagnosis at all.

I wish I could say that I am surprised by what Dr. Cooper found in his survey. But, sadly, I am not. Atypical antipsychotics are grossly overprescribed. This is due in part to medications like Abilify being marketed aggressively. I remember seeing one of those melancholy "are you depressed?" medication ads on television and nearly having a seizure when I saw that the medication advertised was Abilify. (The Better Half has gotten very good at listening patiently while I rant and gesticulate wildly at the television in such circumstances.) A large part of the fault lies, sad to say, with doctors who are all too willing to cavalierly prescribe new, potent medications with little understanding (and even less discussion) of the ill effects that could be experienced.

I try to prescribe medications of this type very, very, very rarely. (Very.) Sometimes, while my patients languish on interminable wait lists for psychiatric intake appointments, I have little choice. But I can only hope that more study of and publicity for the adverse effects these medications can cause will lead to a lighter prescribing hand amongst members of my profession.


  1. Dr. Dan, I am surprised you have no comment about the Matthew Shepard Bill signed into law today.

    As to your posting, I am not in Medicine so frankly I haven't got a clue if you are right or not, but what you say sounds reasonable. When it comes to medicine I use trust and verify, I take the meds and google it to make sure the recommended dosages, etc. are right. So far I have never seen any mistakes.


  2. So upsetting. So many adults and kids medicated for things that may---may---be treatable without meds. The debate about increased diagnosis usually goes toward increased awareness, but might well be increased pathologizing of stuff we don't have time or energy to figure out and address the root causes of.
    (yup. prepositional ending. happens.)