Children’s Mental Health Woes

Nov 16, 2012
Children are increasingly being prescribed atypical antipsychotics to treat mental health disorders. The Express Scripts Lab explores last decade's trends.
  • Mental/Neurological Disorders
  • Children

Childhood – a time of care-free play and learning. But for children suffering with a mental-health condition, it’s far from an idyllic life. Unfortunately, that experience is not uncommon.

According to a report by the U.S. Department of Health & Human Services, at least one in five children has a mental health disorder at some point between childhood and adolescence. Express Scripts research shows that the number of children prescribed a medication to treat a psychiatric or behavioral condition increased nearly 15% from 2001 to 2010. The fact that these numbers have been rising over time may indicate that more children are developing these behavioral conditions or we’ve gotten better at identifying and treating them – likely a combination of the two.

Children's Increased Use of Mental Health Medications

There are intriguing insights on the state of children’s mental health and their treatment that can be garnered from our America's State of Mind report. The report examined the use of antidepressants, antipsychotics, anti-anxiety drugs and treatments for attention deficit hyperactivity disorder (ADHD) during the first decade of this millennium.

Historically, more boys take mental health medications than girls, with antidepressants being the one exception. While this is still the case, girls are quickly catching up as their use of these drugs increased at double the rate of their male counterparts over the past decade.

While the actual number of children being treated with atypical antipsychotics is quite small, there’s been a significant uptick in the use of these drugs especially among girls; prevalence among girls rose 131% from 2001 to 2010 ,while boys' use was up 93% over the same time frame.

increase in children on atypical antipsychotics

How Atypical Antipsychotics Work

Atypical antipsychotics have become popular in this drug category, treating a range of disorders including schizophrenia, depression and bipolar disorder. While they do not have many of the severe side effects of conventional antipsychotics, they do pose risks – especially for children. Studies from the past few years have repeatedly shown that children and adolescents are more vulnerable than adults to the negative metabolic effects associated with atypicals, including weight gain, elevated cholesterol and Type 2 diabetes – all major risk factors for heart disease. A 2007 study found that people using atypicals were 9% more likely to develop Type 2 diabetes than patients on conventional antipsychotics.

Making the Use of Mental Health Medications Safer for Children

Given these serious risks, all patients using these medications – but particularly children – should have a baseline screening and routine monitoring of their glucose and triglyceride levels. Unfortunately, testing is not being done on a regular basis. More than half of all people taking atypicals do not receive a basic blood sugar test during the course of a year’s exposure to the medication. It’s critical that a child on any dose of any atypical antipsychotic be rigorously monitored, and if a problem is detected, the medication management plan should be re-evaluated, including consideration of substituting a safer alternative.

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