There are concerns doctors are prescribing powerful anti-psychotic medications to troubled children and teens to help them get to sleep.
Parents and health experts have said it has become common for psychiatrists to prescribe anti-psychotic medication to young people to overcome the sleeplessness that comes with anti-depressant medication.
The concerns were first raised by a mother last year in a submission to the National Children’s Commissioner at the Human Rights Commission.
The mother, who did not want to be identified, spent three years dealing with the mental health system after her daughter’s thyroid condition was misdiagnosed as depression.
Child psychiatrist Jon Jureidini has backed her concerns and said it had become too common for the drugs to be prescribed as a sedative among young people.
The drugs have not been properly studied for use in children and teens and are prescribed by GPs off-label, which means it is not an approved use.
Dr Jureidini said prescriptions for anti-psychotics to children were increasing at a “disturbing rate” and that they were dangerous drugs.
“They can cause severe neurological problems and severe metabolic problems like obesity and diabetes,” he said.
“Those might be risks worth taking when you’re dealing with disturbed and distressed people, but it’s certainly not a risk worth taking when you’re dealing with people having difficulty sleeping.”
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) said there were clear guidelines for prescribing the drugs off-label, but more research was needed to understand the reasons why doctors prescribed the medication.
Dr Nick Kowalenko, who is the college’s child and adolescent psychiatry chair, said he was not aware of the use of the drugs purely as a sedative to counter anti-depressant use.
However, he said GPs and paediatricians also prescribed the drugs.
“There’s education in the profession generally about prescribing anti-psychotics,” he said.
“Some of the indications for treatment with anti-psychotics aren’t necessarily mental illnesses — there’s conditions like behaviour difficulties in the child and adolescents that have autism.
“Who is prescribing and what are the issues we don’t always have information about.”
Powerful drug cocktails concerning
Dr Jureidini said little research had been done on the impact of anti-psychotics when combined with anti-depressants in young people.
“If I were a parent and my child was being prescribed two different psychiatric medications, I’d want to have a very good explanation given to me by the doctor as to why that was judged to be more helpful than harmful,” he said.
The medications have also come under scrutiny for their use as a sedative in nursing homes.
Dr Jureidini said the medications were more often being prescribed as a sedative for youths in outpatient practices than on hospital wards, but despite concerns little was being done.
“We’re competing against the pharmaceutical industry, which has a huge investment in marketing these drugs and convinces doctors that it’s a good idea, and those doctors in turn influence other doctors,” he said.
The RANZCP said a better approach to serious cases of sleeplessness was to discontinue the anti-depressants or to try another one.
“It’s important people have a trial [of anti-psychotics] so their impact is monitored,” Dr Kowalenko said.
“It’s only if they’re shown to have positive impact their prescription should continue.”
Parents blame medications for deaths
A report written by National Children’s Commissioner, Megan Mitchell, says the contribution of medications to self harm and suicide in Australia is an area that needs further work and investigation.
“I received a number of submissions that questioned the appropriateness of prescribing retinoid and psychotropic medications to children and young people,” she said.
“Some of these were from parents who maintained that their child only became suicidal, and died due to intentional self harm, as a result of the medication.”
The RANZCP supports her position that more research is needed.