Too Many Meds?

Since taking Charlie to a different neurologist last month, we've been considering changing his medications (he currently takes Risperdal and Zoloft; dosages are low---in fact, the dosages are not much increased since he started taking these meds a few years ago, and Charlie has grown quite a bit since then). Deciding to give him medication---for aggression, and anxiety, and to help him with self-injurious behaviors----was not an easy decision to make. And though Charlie's now been taking medication for some years, this particular topic remains full of questions and uncertainties, and the latest reports about medications like Risperdal only raise more.

A Los Angeles Times article (dated April 13) asks if there's been "too hard a sell"---by psychiatrists and doctors, by manufacturers---to use atypical antipsychotics for disorders "far less severe than schizophrenia and bipolar disorder -- afflictions such as anxiety, sleep difficulties, depression, attention deficit disorder and autism." The FDA and its advisory panels are, according to the LA Times, starting to raise some concerns, but "many public health experts" are saying that these are being raised too late. While these medications were once solely prescribed for adults, they are now being used in children as young as two. (Read some of the comments on a post I wrote on Autism Vox back in October of 2006 and you'll find some parents of quite young children saying that their doctors are prescribing Risperdal.)

The LA Times continues:

The sales of atypical antipsychotics have skyrocketed in recent years, propelling overall sales of antipsychotic drugs past all other classes, to $14.6 billion in 2008, according to IMS Health, a private firm that tracks drug trends. In 2008, 50 million prescriptions for antipsychotics, mostly the new ones, were filled in the U.S. -- a 5% hike in one year alone.

In the process, the spreading use of these costly drugs is raising -- for the nation as well as individual patients -- the rates and the risks of weight gain, diabetes, strokes, fatal heart attacks, an array of movement disorders and potentially, suicide, according to a wide range of critics.

While the medications have helped people, the LA Times questions the claims of their greater efficacy, and raises many concerns about side-effects:

A landmark 2005 study concluded that the drugs have brought marginal improvements at much greater expense than traditional antipsychotics in their primary use of treating schizophrenia. The CATIE study (for Clinical Antipsychotic Trials of Intervention Effectiveness) compared four of the atypicals -- Zyprexa, Geodon, Seroquel and Risperdal -- with the first-generation antipsychotic perphenazine (Trilafon), a drug costing on average a tenth the price of the newer drugs. It found the risk of tremors and tardive dyskinesia to be the same for all. And while all the antipsychotics are associated with weight gain, it was more frequent and more likely to be extreme among patients taking atypicals -- leading many to develop diabetes.

Last December, the British journal Lancet published a comprehensive analysis that further punctured the new drugs' claims to superiority. A separate study found Seroquel by many measures to be no more effective in treatment of schizophrenia symptoms than Haldol. And a 2008 study on Abilify found it was little better at banishing depressive symptoms than a placebo.

So often in trying to figuring out how to help a child on the spectrum, parents seem to be in search of a "magic pill." More often's the case that, you try one thing, it works at first, it works for awhile, it seems to be working----your child has a terrible awful day---you feel like you're back to square one. In Charlie's case, this has seemed particularly true when it comes to medication. Because of his limited language, we've had to infer how the medication is working (or not) by observing him and listening to the reports of his teachers and therapists. And all the time, we're keenly aware that those little orange and pale blue bills are powerful stuff whose long-term effects on children are not well known.

At this point, my son does need to take some meds. The questions about which ones and how much (not much, preferably) remain and I don't think they're going to go away. Sometimes (too often) in trying to do the best for your child, you have to question every decision you make---indeed, I think that if I didn't do this, I wouldn't be a good advocate for my son.