Wednesday, October 28, 2009

No kidding...

This article was posted elsewhere, and I really had to put into words my thoughts on why this study bothered me. It concerns a recent study of a link between atypical antipsychotic medications and weight gain in children. I've read where Risperdal (and others similar) are being used for some anorexia patients, so that speaks volumes as to this being an issue. But the focus of the study was on CHILDREN in particular.

Weighing scales

[Abilify and Risperdal are the only two of the four drugs approved as pediatric treatments, for the severe mental conditions schizophrenia and bipolar disorder — and in Risperdal’s case, for some children with autism. More than 70 percent of atypical antipsychotics’ use in young children and teenagers has been off-label prescriptions for nonpsychotic conditions like attention deficit hyperactivity disorder, according to Stephen Crystal, a Rutgers University professor who studies the drugs. ]

I would venture to guess since ADHD is often misdiagnosed for what is actually early-onset or pediatric bipolar, the pediatric ADHD patients being prescribed antipsychotic drugs were actually presenting with aggression, mania and depression, but not actually dx with bipolar disorder. The doctors were likely treating the symptoms, but not labeled the disorder beyond what was an ADHD dx. The article makes it sound as if parents and pdocs are jumping all over these medications for "non-psychiatric" behavioral/attention problems, when I am feeling certain that is not the case. So the public perception is going to be very skewed by reading this article. Where is the study on how many children are indeed bipolar, but being labeled as ADHD because the DSM-IV is light years behind in recognizing that adult bipolar presents differently than childhood bipolar?

My son is on Lamictal, which is an anti-seizure medication, also used off label, with a black box warning to treat bipolar disorder. It's not approved for children under 18 in the treatment of BP, but is approved for seizure disorders in children as young as 2. It also carries less of a risk of metabolic issues and less monitoring for physical side effects, which is why it was the first choice of my son's pdoc. It's not without it's own serious risks however (Stevens-Johnson), but it hasn't caused him to gain significant weight and has improved his quality of life - enough to keep him from being hospitalized. If the Lamictal ceases to be effective, we'll have to look to other medications - maybe even Risperdal or similar. I can say, having experienced life without a mood stabilizer for my child, I would take a weight gain and a rolly-polly kid (and the potential health problems that may come with that) over losing my child completely to a mental illness that caused him to think it was acceptable to tie a jump rope around his neck on his bunk bed, or throw a skateboard at my head. There's no easy answer for parents of children with serious mental illnesses and disorders that can potentially take your child from you or take away any chance at a normal life. You do the best you can.

I can't imagine that most parents take medicating their child with antipsychotic drugs lightly, but rather hate that they are forced to make difficult and scary choices that they and their children can live with. Surely most parents whose kids are on these medications are fully aware of the side effects, and hate that these medications have side effects at all, but they have no choice. It's either the risky medications or a psychiatric hosptial -- where they'll give them the meds anyway and maybe even dope them up to a point they can't function any longer just to stablize them.

A study like this comes as no suprise to most people who either prescribe, dispense, and take the medications. We know the risks. We also know the risks of NOT taking them. It does however, place one more misguided perception (we're over-medicating our kids, we are lazy parents, we don't want to deal with the issues, etc., etc...) on families who are already living with the stigma of a raising a mentally ill or neurologically-disordered child who needs medication to function.

Instead of studying weight gain in these children, why not take those dollars and instead fund a study to find a way to help them get properly diagnosed and treated and included in the DSM-IV?


marythemom said...

My children have been misdiagnosed, incorrectly medicated, suffered from major side effects (including weight loss, weigh gain, and a zombie-like state). At the same time, I can't imagine them without medications. They take so many medications between the two of them: Trileptal, Concerta, Lamictal, Seroquel, Abilify, Amantadine... it used to be more.

I wish meds would actually treat all their illnesses instead of just the bipolar and some of the symptoms. I wish the DSM IVR or whatever version we're up to were correct for them, and included correct diagnoses and treatment for complex PTSD and RAD. I wish the insurance companies bothered to understand it. I wish teachers and therapists were required to be trained in it.

Thank you for this post. You did a good job.

Mary in TX
Mom to biokids Ponito(10) and his sister Bob(13)
Sibling pair adoptive placement from NE foster care 11/06
Finally finalized on Kitty(14) on 3/08 - 2 weeks before her 13th birthday!
RAD, C-PTSD, Bipolar Disorder, ODD, ADHD, learning disorders, cerebral dysrhythmia
Finalized on her brother Bear(16) 7/08. He turned 15 the next day.
RAD, C-PTSD, Bipolar Disorder, ADD, cerebral dysrhythmia

" Life isn't about how to survive the storm, but how to dance in the rain."

Ryansmom said...

"I wish the DSM IVR or whatever version we're up to were correct for them, and included correct diagnoses and treatment for complex PTSD and RAD. I wish the insurance companies bothered to understand it. I wish teachers and therapists were required to be trained in it."

Amen, Mary! And thank you.

Fortunately, the medication my son is on also helps with the complex PTSD, attachment and ADHD symptoms, so that was an unexpected (but welcome) bonus. But still, we have miles to go in the dx and treatment of brain disorders in children. It's shameful that we have to treat our kid's illnesses on a wing and a prayer. They deserve better than that.

Essie the Accidental Mommy said...

I have 2 thoughts on your most excellent post. Having direct personal experience with a very similar situation! Lamictal requires a low starting dose and slow increases in the beginning. But if it shows success it can be increased quite a bit and I have seen that help immensely.
Also, there is clonodine. Our psych told us that it neutralizes adrenaline. My daughter would get so amped up she would be over the top in seconds with no way to intervene, help her or calm her.
When it comes to my daughter, sometimes she will have very strong feelings for no apparent reason. When that happens she will search out something to hang her feelings on. She is only 6 and her emotional psychiatric issues are complex to say the least. So I think at times a chemical wave overtakes her brain and she blows out for no other reason. But her mind searches out a tangible excuse and often she comes up with some random odd thing, like she really wanted tacos for dinner 3 days prior. If that is the last thing she can remember being upset about, then it makes sense to her, and maybe it is true. But a lot of times I think there is nothing logical to it.
Best wishes to your son. I so completely understand!