Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly TIME Healthland - TIME Healthland - TIME.com

[Guest guest]

http://healthland.time.com/2011/05/26/why-children-and-the-elderly-are-so-drugge\

d-up-on-antipsychotics/

Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly

Posted by Maia Szalavitz

May 26, 2011 at 9:45 am

Pharmaceutical companies have recently paid out the largest legal settlements in

U.S. history — including the largest criminal fines ever imposed on corporations

— for illegally marketing antipsychotic drugs. The payouts totaled more than $5

billion. But the worst costs of the drugs are being borne by the most vulnerable

patients: children and teens in psychiatric hospitals, foster care and juvenile

prisons, as well as elderly people in nursing homes. They are medicated for

conditions for which the drugs haven't been proven safe or effective — in some

cases, with death as a known possible outcome.

The benefit for drug companies is cold profit. Antipsychotics bring in some $14

billion a year. So-called " atypical " or " second-generation " antipsychotics like

Geodon, Zyprexa, Seroquel, Abilify and Risperdal rake in more money than any

other class of medication on the market and, dollar for dollar, they are the

biggest selling drugs in America. Although these medications are primarily

approved to treat schizophrenia and bipolar disorder, which combined affect 3%

of the population, in 2010 there were 56 million prescriptions filled for

atypical antipsychotics.

In a presentation this week at an American Psychiatric Association meeting, Dr.

Goethe, director of the Burlingame Center for Psychiatric Research in

Connecticut, reported that over the last 10 years, more than half of all

children aged 5 to 12 in psychiatric hospitals were prescribed antipsychotics —

and 95% of these prescriptions were for second-generation antipsychotics.

Many of these children didn't have a condition for which the drugs have been

shown to be helpful: 44% of youngsters with post-traumatic stress disorder

(PTSD) and 45% of children with attention deficit hyperactivity disorder (ADHD)

were treated with them.

(More on TIME.com: SPECIAL: Kids and Mental Health)

Pharmacologically, the ADHD prescriptions make no sense: FDA-approved drugs for

the condition raise levels of the neurotransmitter dopamine, while

antipsychotics do the opposite, lowering them.

Goethe also noted another study that showed that the number of office visits by

children and teens that included antipsychotic drug prescriptions rose 600% from

1993 to 2002. " The obvious second-generation bias is very apparent in these

data, as is the irrational use of antipsychotics for indications such as PTSD

and ADHD for which there is no controlled evidence whatsoever that these are

safe or effective treatments, " says Dr. Bruce , senior fellow at the

ChildTrauma Academy in Houston. (Full disclosure: Dr. is my co-author on

two books.)

The situation is similar in state-run juvenile detention systems. Late last

week, an exposé by the Palm Beach Post revealed that antipsychotics were among

the top drugs purchased by the Florida Department of Juvenile Justice (DJJ), and

were largely used in kids for reasons that were not approved by the government —

for instance, sleeplessness or anxiety. The Post reported:

In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen.

Overall, in 24 months, the department bought 326,081 tablets of Seroquel,

Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails

and homes for children.

That's enough to hand out 446 pills a day, seven days a week, for two years in a

row, to kids in jails and programs that can hold no more than 2,300 boys and

girls on a given day.

Among the psychiatrists hired by the state to evaluated incarcerated kids, about

a third received drug company money, the Post reported. Those 17 psychiatrists

wrote 54% of the prescriptions for antipsychotics; the 35 doctors who did not

take such payments wrote the rest. In other words, one-third of doctors — all of

whom were paid by drug companies — wrote more than half of all antipsychotic

prescriptions for the state's locked-down youth.

(More on TIME.com: Perspective: Why Comparing Painkiller Addiction to Crack

Worsens the Problem)

The statistics on children in foster care are equally alarming. Youth in foster

care are not only three times as likely to be medicated as comparable low-income

youth on Medicaid, but more than half are treated with antipsychotics. It is not

likely that all or even most of these children have a condition for which

antipsychotics have been approved by the government to treat.

Among the problems with unnecessary use of antipsychotic medications is that

they can cause serious, sometimes irreversible, damage. Atypical antipsychotics

are associated with weight gain and may double users' risk of Type 2 diabetes.

Recent research also suggests that they may shrink the brain and there is little

data on how they affect brain development during the teen years, when the brain

grows more than at any other time but infancy. Indeed, youth are more vulnerable

than any other group to the drugs' worst side effects (with the possible

exclusion of death).

(More on TIME.com: Why Has Childhood Bipolar Disorder Become an Epidemic?)

" The majority of antipsychotic medication use in children and adolescents has

not been limited to the few age groups or conditions for which there is credible

evidence of efficacy and safety, " says . " There is no reason to expect

irrational prescribers to change their bad habits. "

He adds that many experts would argue that if doctors began prescribing

antipsychotics " responsibly and cautiously " — that is, being mindful of the lack

of efficacy data and the evidence of harm — the rate of prescriptions in

children would drop by 90%.

Meanwhile, prescribing at the other end of the lifespan is also out of control.

In nursing homes, 14% of residents have been given at least one prescription for

a second-generation antipsychotic, according to a government investigation. A

full 88% of these prescriptions are given to people with dementia, despite the

fact that these drugs may double the risk of death in these patients (there is a

black box warning on the drug to this effect). The investigation estimated that

$116 million Medicare dollars have been spent filling antipsychotic

prescriptions that never should have been written.

So why are these drugs so widely prescribed? Aggressive drug company marketing

is only one part of the story. A key reason they are overused in institutional

settings is that they are sedating, making patients easier to manage. Secondly,

unlike other sedative drugs, they are not associated with misuse (except perhaps

Seroquel, which has fans among some addicts). In fact, most people resist taking

antipsychotics, which is why overmedication is much more common in settings

where people are locked-in and compliance can be forced.

(More on TIME.com: Top Ten Legal Drugs Linked to Violence)

The fact that the drugs are not associated with addiction is another big part of

why drug companies have been able to get away with so much misleading marketing

and the resultant overprescribing. Unlike traditional sedatives like

benzodiazepines (Valium or Xanax), which are controlled substances, few people

enjoy misusing antipsychotics. With side effects like weight gain,

pleasurelessness, movement disorders, and low energy and motivation, there's not

much of a recreational market.

Consequently, they can be prescribed for unapproved uses like behavior control

and sleep-inducement in children and the elderly, without government scrutiny or

fear of prosecution for " overprescribing. "

In other words, addiction is basically seen as a worse side effect than, say,

death (or any other outcome such as Type 2 diabetes or the complete inability to

feel pleasure). The fact that the most vulnerable youth and elderly often cannot

advocate for themselves has made it easier to sweep the problem under the rug.

(More on TIME.com: U.S. Aims to Reduce Overdose Deaths, But Will the New Plan

Work?)

Fortunately, there is at least one bright spot in this depressing picture. The

main patent on Risperdal expired in 2007, and those for Zyprexa and Seroquel

expire this year. Geodon's patent expires next year, while Abilify's comes up in

2015. When most drugs go off-patent, drug companies' marketing pressure — and

profits — will subside, perhaps keeping children and the elderly safer from

inappropriate medication.

Sent via BlackBerry by AT & T

[Guest guest]

http://healthland.time.com/2011/05/26/why-children-and-the-elderly-are-so-drugge\

d-up-on-antipsychotics/

Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly

Posted by Maia Szalavitz

May 26, 2011 at 9:45 am

Pharmaceutical companies have recently paid out the largest legal settlements in

U.S. history — including the largest criminal fines ever imposed on corporations

— for illegally marketing antipsychotic drugs. The payouts totaled more than $5

billion. But the worst costs of the drugs are being borne by the most vulnerable

patients: children and teens in psychiatric hospitals, foster care and juvenile

prisons, as well as elderly people in nursing homes. They are medicated for

conditions for which the drugs haven't been proven safe or effective — in some

cases, with death as a known possible outcome.

The benefit for drug companies is cold profit. Antipsychotics bring in some $14

billion a year. So-called " atypical " or " second-generation " antipsychotics like

Geodon, Zyprexa, Seroquel, Abilify and Risperdal rake in more money than any

other class of medication on the market and, dollar for dollar, they are the

biggest selling drugs in America. Although these medications are primarily

approved to treat schizophrenia and bipolar disorder, which combined affect 3%

of the population, in 2010 there were 56 million prescriptions filled for

atypical antipsychotics.

In a presentation this week at an American Psychiatric Association meeting, Dr.

Goethe, director of the Burlingame Center for Psychiatric Research in

Connecticut, reported that over the last 10 years, more than half of all

children aged 5 to 12 in psychiatric hospitals were prescribed antipsychotics —

and 95% of these prescriptions were for second-generation antipsychotics.

Many of these children didn't have a condition for which the drugs have been

shown to be helpful: 44% of youngsters with post-traumatic stress disorder

(PTSD) and 45% of children with attention deficit hyperactivity disorder (ADHD)

were treated with them.

(More on TIME.com: SPECIAL: Kids and Mental Health)

Pharmacologically, the ADHD prescriptions make no sense: FDA-approved drugs for

the condition raise levels of the neurotransmitter dopamine, while

antipsychotics do the opposite, lowering them.

Goethe also noted another study that showed that the number of office visits by

children and teens that included antipsychotic drug prescriptions rose 600% from

1993 to 2002. " The obvious second-generation bias is very apparent in these

data, as is the irrational use of antipsychotics for indications such as PTSD

and ADHD for which there is no controlled evidence whatsoever that these are

safe or effective treatments, " says Dr. Bruce , senior fellow at the

ChildTrauma Academy in Houston. (Full disclosure: Dr. is my co-author on

two books.)

The situation is similar in state-run juvenile detention systems. Late last

week, an exposé by the Palm Beach Post revealed that antipsychotics were among

the top drugs purchased by the Florida Department of Juvenile Justice (DJJ), and

were largely used in kids for reasons that were not approved by the government —

for instance, sleeplessness or anxiety. The Post reported:

In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen.

Overall, in 24 months, the department bought 326,081 tablets of Seroquel,

Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails

and homes for children.

That's enough to hand out 446 pills a day, seven days a week, for two years in a

row, to kids in jails and programs that can hold no more than 2,300 boys and

girls on a given day.

Among the psychiatrists hired by the state to evaluated incarcerated kids, about

a third received drug company money, the Post reported. Those 17 psychiatrists

wrote 54% of the prescriptions for antipsychotics; the 35 doctors who did not

take such payments wrote the rest. In other words, one-third of doctors — all of

whom were paid by drug companies — wrote more than half of all antipsychotic

prescriptions for the state's locked-down youth.

(More on TIME.com: Perspective: Why Comparing Painkiller Addiction to Crack

Worsens the Problem)

The statistics on children in foster care are equally alarming. Youth in foster

care are not only three times as likely to be medicated as comparable low-income

youth on Medicaid, but more than half are treated with antipsychotics. It is not

likely that all or even most of these children have a condition for which

antipsychotics have been approved by the government to treat.

Among the problems with unnecessary use of antipsychotic medications is that

they can cause serious, sometimes irreversible, damage. Atypical antipsychotics

are associated with weight gain and may double users' risk of Type 2 diabetes.

Recent research also suggests that they may shrink the brain and there is little

data on how they affect brain development during the teen years, when the brain

grows more than at any other time but infancy. Indeed, youth are more vulnerable

than any other group to the drugs' worst side effects (with the possible

exclusion of death).

(More on TIME.com: Why Has Childhood Bipolar Disorder Become an Epidemic?)

" The majority of antipsychotic medication use in children and adolescents has

not been limited to the few age groups or conditions for which there is credible

evidence of efficacy and safety, " says . " There is no reason to expect

irrational prescribers to change their bad habits. "

He adds that many experts would argue that if doctors began prescribing

antipsychotics " responsibly and cautiously " — that is, being mindful of the lack

of efficacy data and the evidence of harm — the rate of prescriptions in

children would drop by 90%.

Meanwhile, prescribing at the other end of the lifespan is also out of control.

In nursing homes, 14% of residents have been given at least one prescription for

a second-generation antipsychotic, according to a government investigation. A

full 88% of these prescriptions are given to people with dementia, despite the

fact that these drugs may double the risk of death in these patients (there is a

black box warning on the drug to this effect). The investigation estimated that

$116 million Medicare dollars have been spent filling antipsychotic

prescriptions that never should have been written.

So why are these drugs so widely prescribed? Aggressive drug company marketing

is only one part of the story. A key reason they are overused in institutional

settings is that they are sedating, making patients easier to manage. Secondly,

unlike other sedative drugs, they are not associated with misuse (except perhaps

Seroquel, which has fans among some addicts). In fact, most people resist taking

antipsychotics, which is why overmedication is much more common in settings

where people are locked-in and compliance can be forced.

(More on TIME.com: Top Ten Legal Drugs Linked to Violence)

The fact that the drugs are not associated with addiction is another big part of

why drug companies have been able to get away with so much misleading marketing

and the resultant overprescribing. Unlike traditional sedatives like

benzodiazepines (Valium or Xanax), which are controlled substances, few people

enjoy misusing antipsychotics. With side effects like weight gain,

pleasurelessness, movement disorders, and low energy and motivation, there's not

much of a recreational market.

Consequently, they can be prescribed for unapproved uses like behavior control

and sleep-inducement in children and the elderly, without government scrutiny or

fear of prosecution for " overprescribing. "

In other words, addiction is basically seen as a worse side effect than, say,

death (or any other outcome such as Type 2 diabetes or the complete inability to

feel pleasure). The fact that the most vulnerable youth and elderly often cannot

advocate for themselves has made it easier to sweep the problem under the rug.

(More on TIME.com: U.S. Aims to Reduce Overdose Deaths, But Will the New Plan

Work?)

Fortunately, there is at least one bright spot in this depressing picture. The

main patent on Risperdal expired in 2007, and those for Zyprexa and Seroquel

expire this year. Geodon's patent expires next year, while Abilify's comes up in

2015. When most drugs go off-patent, drug companies' marketing pressure — and

profits — will subside, perhaps keeping children and the elderly safer from

inappropriate medication.

Sent via BlackBerry by AT & T

[Guest guest]

http://healthland.time.com/2011/05/26/why-children-and-the-elderly-are-so-drugge\

d-up-on-antipsychotics/

Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly

Posted by Maia Szalavitz

May 26, 2011 at 9:45 am

Pharmaceutical companies have recently paid out the largest legal settlements in

U.S. history — including the largest criminal fines ever imposed on corporations

— for illegally marketing antipsychotic drugs. The payouts totaled more than $5

billion. But the worst costs of the drugs are being borne by the most vulnerable

patients: children and teens in psychiatric hospitals, foster care and juvenile

prisons, as well as elderly people in nursing homes. They are medicated for

conditions for which the drugs haven't been proven safe or effective — in some

cases, with death as a known possible outcome.

The benefit for drug companies is cold profit. Antipsychotics bring in some $14

billion a year. So-called " atypical " or " second-generation " antipsychotics like

Geodon, Zyprexa, Seroquel, Abilify and Risperdal rake in more money than any

other class of medication on the market and, dollar for dollar, they are the

biggest selling drugs in America. Although these medications are primarily

approved to treat schizophrenia and bipolar disorder, which combined affect 3%

of the population, in 2010 there were 56 million prescriptions filled for

atypical antipsychotics.

In a presentation this week at an American Psychiatric Association meeting, Dr.

Goethe, director of the Burlingame Center for Psychiatric Research in

Connecticut, reported that over the last 10 years, more than half of all

children aged 5 to 12 in psychiatric hospitals were prescribed antipsychotics —

and 95% of these prescriptions were for second-generation antipsychotics.

Many of these children didn't have a condition for which the drugs have been

shown to be helpful: 44% of youngsters with post-traumatic stress disorder

(PTSD) and 45% of children with attention deficit hyperactivity disorder (ADHD)

were treated with them.

(More on TIME.com: SPECIAL: Kids and Mental Health)

Pharmacologically, the ADHD prescriptions make no sense: FDA-approved drugs for

the condition raise levels of the neurotransmitter dopamine, while

antipsychotics do the opposite, lowering them.

Goethe also noted another study that showed that the number of office visits by

children and teens that included antipsychotic drug prescriptions rose 600% from

1993 to 2002. " The obvious second-generation bias is very apparent in these

data, as is the irrational use of antipsychotics for indications such as PTSD

and ADHD for which there is no controlled evidence whatsoever that these are

safe or effective treatments, " says Dr. Bruce , senior fellow at the

ChildTrauma Academy in Houston. (Full disclosure: Dr. is my co-author on

two books.)

The situation is similar in state-run juvenile detention systems. Late last

week, an exposé by the Palm Beach Post revealed that antipsychotics were among

the top drugs purchased by the Florida Department of Juvenile Justice (DJJ), and

were largely used in kids for reasons that were not approved by the government —

for instance, sleeplessness or anxiety. The Post reported:

In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen.

Overall, in 24 months, the department bought 326,081 tablets of Seroquel,

Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails

and homes for children.

That's enough to hand out 446 pills a day, seven days a week, for two years in a

row, to kids in jails and programs that can hold no more than 2,300 boys and

girls on a given day.

Among the psychiatrists hired by the state to evaluated incarcerated kids, about

a third received drug company money, the Post reported. Those 17 psychiatrists

wrote 54% of the prescriptions for antipsychotics; the 35 doctors who did not

take such payments wrote the rest. In other words, one-third of doctors — all of

whom were paid by drug companies — wrote more than half of all antipsychotic

prescriptions for the state's locked-down youth.

(More on TIME.com: Perspective: Why Comparing Painkiller Addiction to Crack

Worsens the Problem)

The statistics on children in foster care are equally alarming. Youth in foster

care are not only three times as likely to be medicated as comparable low-income

youth on Medicaid, but more than half are treated with antipsychotics. It is not

likely that all or even most of these children have a condition for which

antipsychotics have been approved by the government to treat.

Among the problems with unnecessary use of antipsychotic medications is that

they can cause serious, sometimes irreversible, damage. Atypical antipsychotics

are associated with weight gain and may double users' risk of Type 2 diabetes.

Recent research also suggests that they may shrink the brain and there is little

data on how they affect brain development during the teen years, when the brain

grows more than at any other time but infancy. Indeed, youth are more vulnerable

than any other group to the drugs' worst side effects (with the possible

exclusion of death).

(More on TIME.com: Why Has Childhood Bipolar Disorder Become an Epidemic?)

" The majority of antipsychotic medication use in children and adolescents has

not been limited to the few age groups or conditions for which there is credible

evidence of efficacy and safety, " says . " There is no reason to expect

irrational prescribers to change their bad habits. "

He adds that many experts would argue that if doctors began prescribing

antipsychotics " responsibly and cautiously " — that is, being mindful of the lack

of efficacy data and the evidence of harm — the rate of prescriptions in

children would drop by 90%.

Meanwhile, prescribing at the other end of the lifespan is also out of control.

In nursing homes, 14% of residents have been given at least one prescription for

a second-generation antipsychotic, according to a government investigation. A

full 88% of these prescriptions are given to people with dementia, despite the

fact that these drugs may double the risk of death in these patients (there is a

black box warning on the drug to this effect). The investigation estimated that

$116 million Medicare dollars have been spent filling antipsychotic

prescriptions that never should have been written.

So why are these drugs so widely prescribed? Aggressive drug company marketing

is only one part of the story. A key reason they are overused in institutional

settings is that they are sedating, making patients easier to manage. Secondly,

unlike other sedative drugs, they are not associated with misuse (except perhaps

Seroquel, which has fans among some addicts). In fact, most people resist taking

antipsychotics, which is why overmedication is much more common in settings

where people are locked-in and compliance can be forced.

(More on TIME.com: Top Ten Legal Drugs Linked to Violence)

The fact that the drugs are not associated with addiction is another big part of

why drug companies have been able to get away with so much misleading marketing

and the resultant overprescribing. Unlike traditional sedatives like

benzodiazepines (Valium or Xanax), which are controlled substances, few people

enjoy misusing antipsychotics. With side effects like weight gain,

pleasurelessness, movement disorders, and low energy and motivation, there's not

much of a recreational market.

Consequently, they can be prescribed for unapproved uses like behavior control

and sleep-inducement in children and the elderly, without government scrutiny or

fear of prosecution for " overprescribing. "

In other words, addiction is basically seen as a worse side effect than, say,

death (or any other outcome such as Type 2 diabetes or the complete inability to

feel pleasure). The fact that the most vulnerable youth and elderly often cannot

advocate for themselves has made it easier to sweep the problem under the rug.

(More on TIME.com: U.S. Aims to Reduce Overdose Deaths, But Will the New Plan

Work?)

Fortunately, there is at least one bright spot in this depressing picture. The

main patent on Risperdal expired in 2007, and those for Zyprexa and Seroquel

expire this year. Geodon's patent expires next year, while Abilify's comes up in

2015. When most drugs go off-patent, drug companies' marketing pressure — and

profits — will subside, perhaps keeping children and the elderly safer from

inappropriate medication.

Sent via BlackBerry by AT & T

[Guest guest]

http://healthland.time.com/2011/05/26/why-children-and-the-elderly-are-so-drugge\

d-up-on-antipsychotics/

Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly

Posted by Maia Szalavitz

May 26, 2011 at 9:45 am

Pharmaceutical companies have recently paid out the largest legal settlements in

U.S. history — including the largest criminal fines ever imposed on corporations

— for illegally marketing antipsychotic drugs. The payouts totaled more than $5

billion. But the worst costs of the drugs are being borne by the most vulnerable

patients: children and teens in psychiatric hospitals, foster care and juvenile

prisons, as well as elderly people in nursing homes. They are medicated for

conditions for which the drugs haven't been proven safe or effective — in some

cases, with death as a known possible outcome.

The benefit for drug companies is cold profit. Antipsychotics bring in some $14

billion a year. So-called " atypical " or " second-generation " antipsychotics like

Geodon, Zyprexa, Seroquel, Abilify and Risperdal rake in more money than any

other class of medication on the market and, dollar for dollar, they are the

biggest selling drugs in America. Although these medications are primarily

approved to treat schizophrenia and bipolar disorder, which combined affect 3%

of the population, in 2010 there were 56 million prescriptions filled for

atypical antipsychotics.

In a presentation this week at an American Psychiatric Association meeting, Dr.

Goethe, director of the Burlingame Center for Psychiatric Research in

Connecticut, reported that over the last 10 years, more than half of all

children aged 5 to 12 in psychiatric hospitals were prescribed antipsychotics —

and 95% of these prescriptions were for second-generation antipsychotics.

Many of these children didn't have a condition for which the drugs have been

shown to be helpful: 44% of youngsters with post-traumatic stress disorder

(PTSD) and 45% of children with attention deficit hyperactivity disorder (ADHD)

were treated with them.

(More on TIME.com: SPECIAL: Kids and Mental Health)

Pharmacologically, the ADHD prescriptions make no sense: FDA-approved drugs for

the condition raise levels of the neurotransmitter dopamine, while

antipsychotics do the opposite, lowering them.

Goethe also noted another study that showed that the number of office visits by

children and teens that included antipsychotic drug prescriptions rose 600% from

1993 to 2002. " The obvious second-generation bias is very apparent in these

data, as is the irrational use of antipsychotics for indications such as PTSD

and ADHD for which there is no controlled evidence whatsoever that these are

safe or effective treatments, " says Dr. Bruce , senior fellow at the

ChildTrauma Academy in Houston. (Full disclosure: Dr. is my co-author on

two books.)

The situation is similar in state-run juvenile detention systems. Late last

week, an exposé by the Palm Beach Post revealed that antipsychotics were among

the top drugs purchased by the Florida Department of Juvenile Justice (DJJ), and

were largely used in kids for reasons that were not approved by the government —

for instance, sleeplessness or anxiety. The Post reported:

In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen.

Overall, in 24 months, the department bought 326,081 tablets of Seroquel,

Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails

and homes for children.

That's enough to hand out 446 pills a day, seven days a week, for two years in a

row, to kids in jails and programs that can hold no more than 2,300 boys and

girls on a given day.

Among the psychiatrists hired by the state to evaluated incarcerated kids, about

a third received drug company money, the Post reported. Those 17 psychiatrists

wrote 54% of the prescriptions for antipsychotics; the 35 doctors who did not

take such payments wrote the rest. In other words, one-third of doctors — all of

whom were paid by drug companies — wrote more than half of all antipsychotic

prescriptions for the state's locked-down youth.

(More on TIME.com: Perspective: Why Comparing Painkiller Addiction to Crack

Worsens the Problem)

The statistics on children in foster care are equally alarming. Youth in foster

care are not only three times as likely to be medicated as comparable low-income

youth on Medicaid, but more than half are treated with antipsychotics. It is not

likely that all or even most of these children have a condition for which

antipsychotics have been approved by the government to treat.

Among the problems with unnecessary use of antipsychotic medications is that

they can cause serious, sometimes irreversible, damage. Atypical antipsychotics

are associated with weight gain and may double users' risk of Type 2 diabetes.

Recent research also suggests that they may shrink the brain and there is little

data on how they affect brain development during the teen years, when the brain

grows more than at any other time but infancy. Indeed, youth are more vulnerable

than any other group to the drugs' worst side effects (with the possible

exclusion of death).

(More on TIME.com: Why Has Childhood Bipolar Disorder Become an Epidemic?)

" The majority of antipsychotic medication use in children and adolescents has

not been limited to the few age groups or conditions for which there is credible

evidence of efficacy and safety, " says . " There is no reason to expect

irrational prescribers to change their bad habits. "

He adds that many experts would argue that if doctors began prescribing

antipsychotics " responsibly and cautiously " — that is, being mindful of the lack

of efficacy data and the evidence of harm — the rate of prescriptions in

children would drop by 90%.

Meanwhile, prescribing at the other end of the lifespan is also out of control.

In nursing homes, 14% of residents have been given at least one prescription for

a second-generation antipsychotic, according to a government investigation. A

full 88% of these prescriptions are given to people with dementia, despite the

fact that these drugs may double the risk of death in these patients (there is a

black box warning on the drug to this effect). The investigation estimated that

$116 million Medicare dollars have been spent filling antipsychotic

prescriptions that never should have been written.

So why are these drugs so widely prescribed? Aggressive drug company marketing

is only one part of the story. A key reason they are overused in institutional

settings is that they are sedating, making patients easier to manage. Secondly,

unlike other sedative drugs, they are not associated with misuse (except perhaps

Seroquel, which has fans among some addicts). In fact, most people resist taking

antipsychotics, which is why overmedication is much more common in settings

where people are locked-in and compliance can be forced.

(More on TIME.com: Top Ten Legal Drugs Linked to Violence)

The fact that the drugs are not associated with addiction is another big part of

why drug companies have been able to get away with so much misleading marketing

and the resultant overprescribing. Unlike traditional sedatives like

benzodiazepines (Valium or Xanax), which are controlled substances, few people

enjoy misusing antipsychotics. With side effects like weight gain,

pleasurelessness, movement disorders, and low energy and motivation, there's not

much of a recreational market.

Consequently, they can be prescribed for unapproved uses like behavior control

and sleep-inducement in children and the elderly, without government scrutiny or

fear of prosecution for " overprescribing. "

In other words, addiction is basically seen as a worse side effect than, say,

death (or any other outcome such as Type 2 diabetes or the complete inability to

feel pleasure). The fact that the most vulnerable youth and elderly often cannot

advocate for themselves has made it easier to sweep the problem under the rug.

(More on TIME.com: U.S. Aims to Reduce Overdose Deaths, But Will the New Plan

Work?)

Fortunately, there is at least one bright spot in this depressing picture. The

main patent on Risperdal expired in 2007, and those for Zyprexa and Seroquel

expire this year. Geodon's patent expires next year, while Abilify's comes up in

2015. When most drugs go off-patent, drug companies' marketing pressure — and

profits — will subside, perhaps keeping children and the elderly safer from

inappropriate medication.

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