Antipsychotic medications such as Seroquel, Abilify and Risperdal can triple a child's risk of developing type 2 diabetes within the first year of usage, according to a new study.
Powerful antipsychotics traditionally were used to treat schizophrenia. Now the majority of prescriptions for antipsychotic medications are for treatment of bipolar disorder, ADHD and mood disorders such as depression, according to prior research.
But antipsychotic drugs make a child much more likely to develop type 2 diabetes than the medications typically prescribed for these other psychiatric conditions, said corresponding author Wayne Ray, director of the division of pharmacoepidemiology at the Vanderbilt University School of Medicine, in Nashville, Tennessee.
"We found that children who received antipsychotic medications were three times as likely to develop type 2 diabetes," Ray said. "It's well known that antipsychotics cause diabetes in adults, but until now the question hadn't been fully investigated in children."
Antipsychotics appear to increase diabetes risk by causing dramatic weight gain in children and by promoting insulin resistance, Ray said.
Risks on the rise
The boom in the use of antipsychotic medication has been particularly dramatic among children. Antipsychotic prescriptions have increased sevenfold for kids in recent years and nearly fivefold for teens and young adults aged 14 to 20, according to a 2012 study from Columbia University.
For the current study, which was published on 21 August in the journal JAMA Psychiatry, the researchers reviewed the records of nearly 29 000 kids aged 6 to 24 in the Tennessee Medicaid program who had recently started taking antipsychotic drugs for reasons other than schizophrenia or related psychoses.
They compared those kids to more than 14 000 matched control patients who had started taking other types of psychiatric medications, including mood stabilisers such as lithium; antidepressants; psychostimulants such as Adderall and Ritalin; alternative ADHD medications such as clonidine and guanfacine; and anti-anxiety drugs known as benzodiazepines.
Within the first year, users of antipsychotic drugs had triple the risk for type 2 diabetes compared to users of other psychiatric medications.
The risk continued to rise with cumulative antipsychotic dose, and remained high for as long as a year after kids were taken off their antipsychotics. When the researchers looked only at kids 17 and younger, the findings held.
"Diabetes can develop relatively soon after beginning these drugs," Ray said. "We found that the risk was increased within the first year of use, and this is consistent with case reports. The risk may need to be considered even for relatively short periods of use."
The specific antipsychotic medication used with children didn't seem to have any effect on reducing risk of diabetes.
"In our study, we didn't see a difference between different types of drugs," Ray said. "It may be an effect of the whole class of antipsychotics." The majority of participants were taking "atypical" antipsychotics, also called second-generation antipsychotics.
Cause for concern
Another expert agreed that the study results are cause for concern.
The findings should lead doctors and parents to question the "off-label" use of antipsychotic drugs for conditions other than schizophrenia and psychosis, said Dr Ken Duckworth, medical director of the National Alliance on Mental Illness.
"There aren't many antipsychotic medications that are FDA-approved for use in children," Duckworth said. "When you're using a compound that doesn't have an indication, you have to be very careful about the risk/benefit assessment of that medication. You want to make sure you've reviewed all the alternative medicines and alternative strategies."
Ray agreed, arguing that doctors should consider all other alternative treatments before resorting to antipsychotics.
If children must be placed on antipsychotics, then doctors and parents need to keep a close eye on them for early warning signs of diabetes. "Frequent monitoring of the factors that lead to diabetes would be important, including weight and glucose intolerance," Ray said.
In the past 20 years, growing numbers of US children and teens especially overweight kids have been diagnosed with type 2 diabetes, formerly known as adult onset diabetes. This puts them at risk of developing other serious health conditions such as heart disease and kidney disease.
Although the study found an association between the use of antipsychotics and a greatly increased risk of childhood type 2 diabetes, it did not prove a cause-and-effect relationship.
For more information on paediatric antipsychotic medication use, visit the U.S. Food and Drug Administration.