Children in foster care have higher rates of emotional and behavioral problems, physical and developmental disabilities, and do worse in school compared to other children.
And now, mounting evidence suggests that children in foster care are more likely to take multiple antipsychotic medications for longer periods of time than any other group of children. These types of medications include stimulants, antidepressants and mood stabilizers.
A greater number of children with physical, mental and developmental problems are being placed in foster care and are already on the medications. But taking multiple antipsychotics is not generally considered standard medical practice for children, according to Susan dosReis, researcher in the department of pharmaceutical health services research at the University of Maryland and the lead author of a study released November in the journal Pediatrics.
However, thousands of foster and non-foster children have been prescribed doses that are higher than the maximum FDA-approved levels found on the drug labels, according to a new report released Wednesday by the U.S. Government Accountability Office.
Many of the drugs are used "off-label," meaning for purposes other than those they're approved for, because a very limited number of studies have been done testing some types of antipsychotics on children.
"We also don't have long term evidence that looks at the impact long term exposure," said dosReis. "We need to pay attention to how these medicines are prescribed and monitored."
Here's a list of some of the most common drugs that are prescribed:
Abilify Abilify is FDA approved to treat schizophrenia, bipolar disorder in some adolescent and teens, as well as irritability associated with autism spectrum disorder. But the drug is prescribed off-label in children as a mood stabilizer and to treat ADHD symptoms. Abilify received a black box warning label for inducing suicidal feelings in children. In 2009, sales of the drug reached $4 billion.
Seroquel/Seroquel XR Seroquel is approved to treat schizophrenia and acute manic episodes of bipolar disorder in some adolescents and teens. Its long-releasing version, Seroquel XR, is not approved for children. However, both drugs are used off-label as a sedative for children with sleep and anxiety disorders.
Risperdal Risperdal is FDA-approvedto treat acute manic episodes of bipolar disorder and schizophrenia in children as young as age 10. It is also used to manage irritability in children with autism spectrum disorder. The drug is used off-label to treat Tourette syndrome, and anxiety and eating disorders. Risperdal was Johnson & Johnson's fourth-largest-selling drug in 2008, making more than $2 billion in sales.
Zyprexa Zyprexa, also approved to treat acute manic episodes of bipolar disorder and schizophrenia in children as young as age 10, is also used off-label to treat anxiety and eating disorders, depression and Tourette syndrome. One of the most common side effects noted in the drug has been serious weight gain. In 2007, manufacturer Eli Lilly agreed to pay $500 million to settle 18,000 lawsuits from people who claimed they developed diabetes from taking Zyprexa.