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Psychiatric Drugs and Poor Kids

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Children covered by Medicaid are far more likely to be prescribed antipsychotic drugs than children covered by private insurance, and Medicaid-covered kids have a higher likelihood of being prescribed antipsychotics even if they have no psychotic symptoms. This is reported in the May19, 2010 Journal of American Medical Association (JAMA) article, "Studies Shed Light on Risks and Trends in Pediatric Antipsychotic Prescribing."

Researchers at Rutgers University and Columbia University found that children and adolescents covered by Medicaid were four times as likely as those with private insurance to receive an antipsychotic in 2004. Among those aged six to 17 years who were covered by Medicaid, 4.2 percent were prescribed at least one antipsychotic drug. In contrast, among those in this same age group who had private insurance, less than 1 percent were prescribed an antipsychotic. Nearly half of these Medicaid-covered pediatric patients receiving antipsychotic drugs had nonpsychotic diagnoses of attention deficit hyperactivity disorder (ADHD) or some other disruptive behavior disorder. In contrast, of the privately insured pediatric patients receiving antipsychotics, about one fourth were diagnosed with ADHD or some other disruptive behavior disorder.

The current issue of JAMA also reports another troubling study published earlier this year in the journal Pediatrics. This study, conducted by Robert Penfold of the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, examined the use of the antipsychotic Geodon (ziprasidone) in pediatric patients covered by Medicaid in Michigan in 2001. Of the pediatric patients who had been diagnosed with a psychiatric disorder and had received Geodon, only 53.3 percent actually had a diagnosis of psychosis. The other children who received Geodon had one or more of the following diagnoses: 24.1 percent were diagnosed with explosive personality disorder, 17.6 percent were diagnosed with depressive disorder, and 13.1 percent of these kids who were prescribed Geodon had oppositional defiant disorder (ODD). What exactly does it take to get an ODD diagnosis? Four of the following eight symptoms must persist for at least six months:
• Often loses temper.
• Often argues with adults.
• Often actively defies or refuses to comply with adult requests or rules.
• Often deliberately does things to annoy other people.
• Often blames others for their mistakes.
• Often touchy or easily annoyed by others.
• Often angry and resentful.
• Often spiteful or vindictive.

In other words, large numbers of Medicaid-covered kids are being prescribed major tranquilizing and physically dangerous antipsychotic drugs for being rebellious. But it gets even worse. The Pediatrics article reports that nearly a third of the Medicaid-covered pediatric patients who received Geodon had no psychiatric diagnosis.

Antipsychotics have very dangerous physical effects. The current JAMA article refers to an earlier 2009 JAMA study by physician Christoph Correll examining the adverse effects of antipsychotic drugs on patients aged four to 19 years who were seen at clinics in Queens, New York between December 2001 and September 2007. After three months, these antipsychotics caused severe and rapid weight gain, with patients gaining between 4.4 kg and 8.5 kg after a median of 10.8 weeks, while a comparison group gained only 0.2 kg on average. The use of the antipsychotic Zyprexa (olanzapine) and Seroquel (quetiapine) were associated with significant elevations in total cholesterol, triglycerides, non-high-density lipoprotein cholesterol, and the ratio of triglycerides to high density lipoprotein cholesterol. The May 19, 2009 JAMA article notes that Correll's study "adds to a growing body of evidence suggesting that children and adolescents are more vulnerable to antipsychotic adverse events, including not only weight gain and lipid abnormalities, but also sedation, extrapyramidal adverse effects, prolactin elevation, and withdrawal."

In summary, if you are a poor kid in the U.S., you are four times more likely to be prescribed antipsychotic drugs than if you are not poor. Additionally, being poor doubles the chance that you will receive antipsychotic drugs if you only have one of the so-called "disruptive disorders" and are not psychotic. And being poor also means you have a decent chance of receiving antipsychotic drugs even if you have no psychiatric condition at all. Thus, being poor means you have a far better chance of unnecessarily being prescribed the kind of psychiatric drugs that make you overweight and may cause a wide array of severe physical problems.

Increasingly, American kids who create tension for authorities render themselves more likely to be psychiatrically drugged, but it appears that the tension produced by misbehaving poor American kids creates even a greater likelihood that they will be placed on the heavy-hitter chill pills, the antipsychotics.

Bruce E. Levine is a clinical psychologist and author of Surviving America's Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green Publishing).