Antipsychotics Tied to Insulin Problems in Kids

Findings of new study echo link already found for adults

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HealthDay Reporter

THURSDAY, Oct. 21, 2004 (HealthDayNews) -- Prescription drugs commonly used to treat children and teens with aggression, bipolar disorder and schizophrenia may lead to insulin problems, in turn boosting the risk of type 2 diabetes and heart disease later in life, a new study claims.

The research, presented Oct. 20 at the American Academy of Child and Adolescent Psychiatry meeting in Washington, D.C., echoes what's been discovered about these drugs when used in adults, said Dr. Mark Riddle, director of child and adolescent psychiatry at Johns Hopkins University School of Medicine.

His study, he said, is believed to be the first to find the link between the antipsychotic drugs and insulin problems in children and teens.

While the study findings don't mean the drugs should not be prescribed, Riddle said the message for parents is clear: "Work with an experienced clinician and focus on the benefit-risk ratio." All drugs have risks, of course, he said. What's important is to determine if the benefits from these drugs outweigh the risks for individual children.

In the study, Riddle and his co-authors evaluated 11 children, aged 10 to 17, who had gained weight while taking three different antipsychotic drugs -- olanzapine (Zyprexa), quetiapine (Seroquel), or risperidone (Risperdal).

They found that all six subjects on moderate or high doses of these drugs, called atypical or "second-generation" antipsychotics, had what doctors call insulin resistance, in which the body is not using insulin properly. Three of five on the low doses of the same drugs met the criteria for insulin resistance. And eight of the nine subjects found to be insulin-resistant were more insulin-resistant than predicted based on their weight alone.

While the association between excess weight and insulin resistance has been well known, Riddle said it's believed the antipsychotic drugs may have an independent effect on insulin, over and above the effect of excess weight.

The study results echo what has been found in adults, said Dr. Glen R. Elliott, an associate professor and director of the Children's Center at Langley Porter, which is affiliated with the University of California at San Francisco. "There's been an assumption that this is likely to be true [in children]," he said, based on research on adults.

The newer drugs studied, the second-generation drugs, were so named, Elliott said, because they weren't associated with tardive dyskinesia, a movement disorder that was a side effect of the first-generation antipsychotics.

The second-generation drugs work, Riddle said, by binding to receptors for the neurotransmitter dopamine in the brain, affecting the transmission of impulses and helping to change behavior and thinking.

Riddle said more study is needed and the results are not in themselves a reason not to use the drugs. "In certain cases, the use of these antipsychotics are essential for the child to function," said Dr. Charles Goodstein, a clinical professor of psychiatry at New York University Medical School.

Based on anecdotal reports, Goodstein said these agents, like antidepressants, are sometimes over-prescribed. So parents should ask the exact diagnosis and ask why the doctor is prescribing the drug. "These are potent medications, and you don't use them without good reason," he said. These medications are often used for several years. And they are valuable for some children, he added.

The best advice for now? Decide whether the benefits outweigh the risk, Riddle and others agreed.

More information

To learn more about child psychiatric problems, visit the American Academy of Child and Adolescent Psychiatry.

SOURCES: Mark Riddle, M.D., professor and director, child and adolescent psychiatry, Johns Hopkins School of Medicine, Baltimore; Glen R. Elliott, M.D., Ph.D., associate professor and director, Children's Center at Langley Porter, University of California, San Francisco; Charles Goodstein, M.D., psychiatrist, Tenafly, N.J., and clinical professor, psychiatry, New York University Medical School, New York City; Oct. 20, 2004, presentation, American Academy of Child and Adolescent Psychiatry annual meeting, Washington, D.C.

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