Psychiatric Medication Risk in Children

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Psychiatric Medication Risk in Children
By JESSICA WARD JONES, MD, MPH Associate News Editor
Reviewed by John M. Grohol, Psy.D. on June 30, 2010
Psychiatric medicines can have serious side effects in children, including birth defects resulting from their mother’s use of the medication during pregnancy.

A new study of adverse drug reactions in children showed that not only were a large percentage of reactions due to psychiatric medications, but that maternal use of some commonly used medicines resulted in some birth defects.

“A range of serious side effects such as birth deformities, low birth weight, premature birth, and development of neonatal withdrawal syndrome were reported in children under two years of age, most likely because of the mother’s intake of psychotropic medication during pregnancy,” associate professor Lisa Aagard of the University of Copenhagen told ScienceDaily. Aagard and Professor Ebbe Holme Hansard collaborated in studying data from Danish Medicines Agency.

With the dramatic rise of psychiatric diagnoses in children and the resulting increased use of psychiatric medications, some regulatory agencies have issued warnings about the risks associated with use of these medications in children. There is little data documenting the safety or effectiveness of many such medications in children, nor is there clear information about the specific risks. Most data about the potential risks in children comes from anecdotes and single case reports.

Aagard and Hansard analyzed all reports to the Danish National database of adverse drug reactions from 1998 to 2007 for children from birth to age 17. A total of 2,437 reports regarding 4,500 serious drug reactions were filed during this time period. 429 of these reactions were due to drugs classified as psychiatric medications.

Of the 429 reactions due to psychiatric medications, 56 percent were classified as serious.

Half of the psychiatric medication reactions were in adolescents between the ages of 11 and 17, and 45 percent of these were serious.

20 percent of the reactions were in children under the age of 2. All but one of these reactions were categorized as serious, and two of these reactions were fatal. The fatalities were both in newborns caused by rare birth defects thought to be related to maternal use of SSRI antidepressants.

While seven serious adverse drug reactions in the very young children were reported as due to maternal use during pregnancy, Aagard and Hansard suspect other reactions were also due to maternal use.

When the severe side effects were broken down by medication class, the most frequent culprits were psychostimulants in 42 percent of the cases (medications like Ritalin, used most often for conditions such as ADD and ADHD), antidepressants (31 percent), and antipsychotics (24 percent). A smaller number (2.5 percent) were due to sedatives; these reactions were mostly in infants, and all were serious.

Maternal use of psychiatric medication during pregnancy, while often necessary for the health of the mother, is known to have some potential risks. In addition to documented reports of birth defects from certain medications, other complications can occur, including withdrawal syndrome of the newborn, obstetric complications, and long-term neurocognitive or behavioral sequelae.

“Psychotropic medications should not be prescribed in ordinary circumstances because this medication has a long half-life. If people take their medication as prescribed it will be a constantly high dosage and it could take weeks for one single tablet to exit the body’s system. Three out of four pregnancies are planned, and therefore society must take responsibility for informing women about the serious risks of transferring side effects to their unborn child,” suggests Aagard.

Women of childbearing age with mental illness and their physicians face a frustrating lack of information regarding the precise level of risk from specific medications. Most medical literature on the subject concludes with a recommendation for each woman and her physician to carefully consider the risk to the unborn baby of continuing a potentially dangerous medication vs. the risk to the mother of going without a medication that may be critical for her own health.

Depression, bipolar disorder and schizophrenia not only sometimes present for the first time in pregnancy, but pregnancy often can exacerbate these psychiatric illnesses. Untreated mental illness can not only be dangerous to the health of the mother, but can result in poor prenatal health care, poor nutrition, increased substance use, low birth weight, and other risks to the unborn child.

Aagaard’s findings will help provide further information to women who are pregnant or planning a family and parents of children with mental health issues in weighing the risks and benefits of psychiatric medications.

It is very important to consult your own physician before making decisions about changing or stopping any medication.

Aagard and Hansard’s results are published in the June issue of the journal BMC Research Notes.

Source: BMC Research Notes

http://psychcentral.com/news/2010/06/27/psychiatric-medication-risk-in-children/15109.html