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September 2015

Antipsychotic Use in Youth Without Psychosis: A Double-edged Sword

Author Affiliations
  • 1Psychiatry Research, The Zucker Hillside Hospital, North Shore–Long Island Jewish Health System, Glen Oaks, New York
  • 2Department of Psychiatry and Molecular Medicine, Hofstra North Shore LIJ School of Medicine, Hempstead, New York
  • 3Psychiatric Neuroscience Center, The Feinstein Institute for Medical Research, Manhasset, New York
  • 4Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York
  • 5Departments of Psychiatry and Pediatrics, University of Texas Health Science Center at San Antonio
JAMA Psychiatry. 2015;72(9):859-860. doi:10.1001/jamapsychiatry.2015.0632

Antipsychotic medication use in youth has been increasing since the mid-1990s.1 This development, most pronounced in the United States, has raised criticism about potential overuse because antipsychotics are prescribed mainly off-label, and their adverse effect burden for young people is worrisome. During the last decade, mostly short-term efficacy and tolerability data led to the regulatory approval of 6 different second-generation antipsychotics (SGAs) to treat youth with schizophrenia, bipolar mania, irritability associated with autism, and Tourette syndrome. However, youth are more susceptible to acute and long-term adverse effects of antipsychotic medications than are adults, especially weight gain and lipid and glucose abnormalities.2 Prolonged exposure to antipsychotic medications may also diminish brain volume and neuronal density. While volume reductions may actually be related to improved functional brain connectivity and cognitive performance compared with unmedicated patients experiencing their first episode of schizophrenia,3 effects during brain development and in patients without schizophrenia are unknown.