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Use of antipsychotics for child, youth insomnia rises

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The number of Manitoba children and youth being prescribed small doses of antipsychotics to treat insomnia has climbed in recent years, according to a report released Thursday.

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Hey there, time traveller!
This article was published 06/04/2017 (1999 days ago), so information in it may no longer be current.

The number of Manitoba children and youth being prescribed small doses of antipsychotics to treat insomnia has climbed in recent years, according to a report released Thursday.

Doctors in the province prescribed low-dose quetiapine — commonly marketed as Seroquel — to children and youth between the ages of five and 24 at a rate of 86 per 100,000 people in 2008-09. That rate increased to 204 per 100,000 in 2013-14, according to information gathered and analyzed by the Canadian Institute for Health Information.

“The increase we’ve seen is concerning given that it’s not at all recommended for children,” said Tracy Johnson, CIHI’s director of health systems, analysis and emerging issues.

Michelle Siu / The Canadian Press Files Seroquel, an antipsychotic drug intended to treat schizophrenia and bipolar disorder, is being used at increasing rates to treat insomnia in children and youth between the ages of five and 24.

The report found that two groups had the highest prescription rate for low doses of quetiapine: women and young people aged 15 to 24.

CIHI’s report, Unnecessary Care in Canada, takes aim at a number of medical practices it deems superfluous, such as potentially unnecessary CT scans or mammogram screenings, but Johnson said prescribing practices around low-dose quetiapine are of particular concern.

Atypical antipsychotics such as quetiapine have a number of side-effects, including obesity, high blood sugar and high cholesterol.

The drug is used for disorders such as schizophrenia and bipolar disorder, but in small doses it’s often used to fight insomnia.

CIHI found that 88 per cent of young people being prescribed the drug in Manitoba, Saskatchewan and British Columbia were taking less than 400 milligrams per day, a low dose indicative of treatment unrelated to schizophrenia or bipolar disorder. Overall, low-dose prescription rates across the three provinces rose from 104 per 100,000 in 2008-09 to 186 per 100,000 in 2013-14.

Although the report didn’t present data for the rest of the provinces and territories, Johnson said, “If it’s happening in three provinces, it’s likely happening elsewhere.”

But just because it’s happening, doesn’t yet mean it’s cause for alarm.

“If quetiapine is being used as first line medication for insomnia that would be unfortunate,” said Dr. Laurence Katz, head of child and adolescent psychiatry at the University of Manitoba.

“What this indicates is that we need more research and more data to really delineate the extent of the problem — if there is one.”

Manitoba could drill down into the data, Katz suggested, and figure out in low-dose prescription cases whether quetiapine was the first drug prescribed by a doctor or whether the script was written after other drugs and therapies failed.

“If it is being used first line,” he said, “what do we do to try to address that?”

Regardless, Katz cautioned against making assumptions about quetiapine prescriptions.

“Correcting sleep is an essential part of treatment,” he said.

“If an adolescent is depressed and you don’t address their sleep troubles, they will have a more difficult time in their recovery… we have to be careful not to throw the baby out with the bathwater.”

jane.gerster@freepress.mb.ca

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