FDA panel cautiously OKs antipsychotic drugs for kids

Three widely used antipsychotic medications appear safe and effective overall in treating children and teenagers with schizophrenia or bipolar disorder, a U.S. advisory panel said on Wednesday.

The Food and Drug Administration's panel of outside experts backed wider use of the pills -- Eli Lilly and Co's Zyprexa, AstraZeneca's Seroquel and Pfizer's Geodon -- but expressed concern over long-term effects the medications may have in younger patients.

The drugs are already approved for adults and are given to youngsters at a doctor's discretion, reaching $10 billion in combined annual sales. FDA approval would allow the drugmakers to market them specifically for children and teenagers.

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I must say that as a double certified and triple-board eligible neuropsychiatrist, we should all have significant concerns with prescribing these 'major tranquilizers' to anyone, especially those whose brain isnt even finished myelinating. These medications can be life-saving and very appropriate for certain individuals in certain cases - but the fact remains that we have very little long term data on kids and that these are medications that cause significant metabolic changes in our bodies and brains; they should NEVER be prescribed lightly. Our healthcare system in our country is NOT setup to allow Psychiatrists enough time to take into account all of the general medical considerations for these patients and be reimbursed for doing such things, therefore they will be tempted to cut corners (not weighing the patients at each visit, or taking full vital signs, or tracking growth on growth charts, etc) -- let alone the poor GPs which can and do perform these things but get on average 8 min and 3 problems per patient or else it has to be a different visit, etc.

We must NEVER take lightly changing someone's body chemistry/metabolism let alone their BRAIN chemistry and metabolism - and yet we have parts of our country that for lack of other better incentives to have physicians move into the state or graduates from their medical schools go into psychiatry, will short-change patients by having a psychologist take a course in medications and begin to prescribe medicines to adults AND CHILDREN in their states!

For those of us who are conscientious about the enormous physiological data to consider (hormonal, immune, neurological and behavioral) when prescribing these medications, it baffles the mind that someone would even ethically DARE to do this without the proper training or patient-specific data and ability to scientifically/medically interpret that data on a patient-to-patient basis.

Notice in the news article cited above that there is no clear/quick OK-DOKEY for Risperdal - as this is one of the worst ones for changing (indirectly) peoples hormones. Unfortunately it is prescribed often (I myself wrote out several prescriptions today to maintain patients on doses I have inherited them on while I work them up). Again, for some patients, after weighing the risks vs benefits and with proper medical monitoring and metabolic/hormonal screening, it will be life-saving and beneficial--but people flock to our clinic because unfortunately many places rarely even weigh their patients, let alone do blood-work or routine physiological follow-up.

I once heard an 'old' general psychiatrist tell me that "I never met a personality without a body" -- meaning that the mind lives in the soma or body (yeah, the brain is part of our body-I'm biased, I think its the most important part). Without some measures of how your body is doing (to include your brain and its functions) we cannot tell how your mind can be/should be working.

These are powerful medicines and can help, but they should not be prescribed flippantly nor nonchalantly-- A LOT of forthought, medical workup and medical follow-up needs to be added and our healthcare system currently is not set up to support that, with general psychiatrists, fully licensed in their respective states to practice medicine, not being credentialed by certain insurance companies to bill for general medical procedures--so things like blood work or ekg's or eeg's slipping through the cracks or no incentive (actually dis-incentives) to weigh their patients or take blood pressures, heights, calculate BMI's and TRACK ALL OF THOSE THINGS THAT THE MEDICINES THEY ARE PRESCRIBING CAN CHANGE FOR THE WORSE; or the GP who IS credentialed to bill for these things, but has their own set of dis-incentives to actually talk to the patient, and spend the time necessary to do the other piece that psychiatrists as trained physicians CAN DO.

In our country, we have allowed ourselves as patients and physicians, to be split apart - physicians, dult licensed by the state medical boards, not being credentialed by the insurance company to BILL for services is a financial thing, not a medical thing. This sets up dis-incentives for doctors to 'do the right thing' -- which, even when I went to meedical school, was to get the "VITAL" signs. Not just because of vital as in vita (life) but as in these are 'vital' to know about someone.

We must not allow insurance and pharma or any other strong political group to continue to get in the way of the doctor patient relationship-- we need to provide sound, preventive-medicine/wellness-type care in a "do no harm" environment that is open to scientifically-sound integrative medicine centers of care.

In the most technologically advanced democracy that this world has ever seen, it is inconceivable that we even have these dichotomies of care and schisms between those patients who have the luxury of 'concierge-tyoe services and doctors (take the time, do the work up no matter what is needed and without haveing to jump through hoops for 'pre-certification' by a bean-counter whose job is to bar you from getting the test/procedure in the name of good resource management-- not good medicine--and get the medicine/treatment/procedure you actually do need).

Have your doctor TAKE THE TIME to do the medical/lab workup necessary; get to know you; look up prior experiences with meds/labs; and to follow you going forward with labs, ekg's, hormone panels,etc.