Researchers from the Johns Hopkins Children’s Center say treating children with atypical antipsychotics for aggression, bipolar disorder, and schizophrenia may trigger insulin resistance – a condition that increases the risk of developing Type 2 diabetes and heart disease later in life.
The Johns Hopkins team evaluated 11 children, some overweight and others obese, who gained significant amounts of weight while taking the atypical antipsychotic drugs olanzpine, quetiapine, and risperidone. Considerable weight gain is a common side effect of atypical antipsychotic medications, and is also one of the many factors that can contribute to insulin resistance.
All six children on moderate or high doses of one of these drugs, and three of the five children on low doses, had evidence of insulin resistance, a condition in which the body cannot properly use the insulin it produces. This evidence included hypertension, high levels of triglycerides, low levels of high density lipoprotein cholesterol (“good” cholesterol) and increased levels of protein in the urine.
“The insulin resistance seen in these children was greater than what would be expected from weight gain alone, suggesting there is a factor distinct from excess weight that directly induces insulin resistance,” says the study’s lead author, Mark A. Riddle, M.D., Director of the Division of Child and Adolescent Psychiatry at the Children’s Center.
In general, this group of new-generation antipsychotics creates fewer side effects than older drugs used to treat debilitating psychiatric conditions such as schizophrenia. The drugs, which balance certain chemicals in the brain and stabilize mood, have successfully treated countless numbers of children since being introduced in the 1990s.
“Treatments are always a matter of risk and benefit balance,” says Riddle. “Clearly these drugs are an important treatment option. But diabetes and heart disease are serious health issues, so it’s important to further investigate this apparent relationship between atypical antipsychotics and insulin production and consumption.
“We may need to reexamine how we are prescribing these drugs to see if dosage changes can be made to ensure children will continue to receive the benefits of these medications while not putting them at risk for developing other health problems in the future.”
If the study’s findings are confirmed by larger follow-up studies, Riddle says he would expect monitoring of metabolic side effects to become standard practice among clinicians prescribing atypical antipsychotics to children.
Results of the study linking insulin resistance to the use of these antipsychotics were presented on October 20th during the annual meeting of the American Academy of Child and Adolescent Psychiatry in Washington, D.C. Study co-authors were David Cooke, M.D., and Helen Courvoisie, M.D., from the Johns Hopkins Children’s Center.