Antipsychotic prescriptions for children and young people rose between 2000-2019

The proportion of children and young people prescribed antipsychotics in England almost doubled between 2000 and 2019, new research suggests.

The drugs, which have a tranquilising effect, are often used to treat major mental illness, such as schizophrenia, in adults.

However, the medication can be associated with substantial side effects such as sexual dysfunction, infertility, and weight gain leading to diabetes.

We do not think the changes in prescribing necessarily relate to changes in clinical need; rather, it may be more likely to reflect changes in prescribing practice by clinicians

The National Institute for Clinical Excellence has approved the use of some antipsychotics for those under 18 with psychosis or with severely aggressive behaviour from a disorder.

However, the study by The University of Manchester’s Centre for Women’s Mental Health suggests they are prescribed for an increasingly broad range of reasons – the most common being autism.

Researchers looked at the records of 7.2 million children and adolescents, aged three to 18, registered at selected English general practices over the period 2000 to 2019.

They found that although the overall percentage who were prescribed antipsychotics was relatively small, it rose from 0.06% in 2000 to 0.11% in 2019.

The scientists argue that the increasing use of antipsychotics is a cause for concern, given that their safety in children, who are still rapidly developing, has not been fully established.

We do not think the changes in prescribing necessarily relate to changes in clinical need; rather, it may be more likely to reflect changes in prescribing practice by clinicians

Dr Matthias Pierce, senior research fellow at the University of Manchester’s Centre for Women’s Mental Health jointly led the study.

He said: “This study demonstrates a concerning trend in antipsychotic prescribing in children and adolescents.

“We do not think the changes in prescribing necessarily relate to changes in clinical need; rather, it may be more likely to reflect changes in prescribing practice by clinicians.

“However, this study will help clinicians to evaluate the prescribing of antipsychotics to children more fully and will encourage them to consider better access to alternatives.”

Senior author, Professor Kathryn Abel from The University of Manchester said: “Antipsychotic medications continue to have a valuable role in the treatment of serious mental illness.

Broadening use of antipsychotics in developing young people begs questions about their safety over time and demands more research on this topic

“These findings represent a descriptive account of antipsychotic prescribing to children and adolescents in the UK today and provide a window onto current practice.”

She added: “Broadening use of antipsychotics in developing young people begs questions about their safety over time and demands more research on this topic.”

The study published in the Lancet Psychiatry also found that boys and older children – aged 15 to 18 – were more likely to be prescribed antipsychotics than girls and younger children.

Additionally, the older class of antipsychotics, that may be associated with uncontrollable involuntary movements, were more commonly prescribed in more deprived areas.

Indeed, the term ‘antipsychotics’ is not helpful either for clinicians or the wider public

Emily Simonoff, professor of child and adolescent psychiatry, Institute of Psychiatry Psychology & Neuroscience, King’s College, London, (IoPPN), said the findings will not come as a surprise to doctors as there has been emerging evidence for the benefit of this kind of medication for a range of different conditions.

She added: “Indeed, the term ‘antipsychotics’ is not helpful either for clinicians or the wider public.

“It describes the way in which this class of medication was first used, rather than their mode of action.

“This could inadvertently lead people to consider any use that is not for a psychotic disorder to be unwarranted.

“This is not the case, and there is good evidence for their benefits for other conditions such as irritability in autism spectrum disorder.”