Antipsychotic + Antidepressant Combo May Double Diabetes Risk for Youth

Initiating antipsychotics may increase a child’s risk for for type 2 diabetes by nearly 50%, and the risk may double if also taking antidepressants, according to new research published in JAMA Pediatrics.

In the study, researchers from the Children’s Hospital of Philadelphia analyzed national Medicaid data for over 1.3 million children aged 10–18 years with a mental health diagnosis from the Centers for Medicare and Medicaid Services. They found that over 25% of Medicaid-enrolled children receiving prescription medications for behavior disorders were prescribed antipsychotics by 2008, mostly for less severe disorders. Earlier research has shown that 1 in 3 youth in the Medicaid program receiving antidepressants were also taking a concomitant antipsychotic. There has also been an increase in antipsychotic prescribing for healthier children and adolescents without strong supporting safety and efficacy data in treating disruptive behaviors (eg, ADHD). The baseline risk for diabetes among youth who were not exposed to antipsychotics in the study was only 1 in 400, 1 in 260 among those initiating antipsychotics, and at most to 1 in 200 among those who initiated antipsychotics while taking concomitant antidepressants.

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The team recommends that a treatment strategy should be reevaluated periodically to address challenging behaviors. Clinicians and families should agree on a plan to see if an evidence-based counseling service (eg, trauma-focused cognitive therapy) could address underlying emotional trauma, and to also assess the earliest that the child can transition off the antipsychotic to reduce this risk of diabetes.

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