Diabetes Risk in ADHD Children Treated with Atypical Antipsychotics

ADHD children treated with atypical antipsychotics and antidepressants for depression or other behavior disorders are at greater risk for developing diabetes mellitus.

While atypical antipsychotics are traditionally used to treat schizophrenia, I’ve found more and more doctors using them to treat bipolar disorder, agitated depression, anxiety associated with depression, major depressive disorder, oppositional behavior disorder, conduct disorder, and obsessive-compulsive behavior disorder.

It’s currently estimated in excess of 40 children per 1000 children in the U.S. are being treated for one of the above behavior problem diagnoses using second generation (atypical) antipsychotics. This number has increased dramatically since 1996 at which point only about 9 out of 1000 kids ages 5 to 18 years were exposed to these drugs.

Unfortunately, with increasing use of atypical antipsychotics and antidepressants, significant side effects of these medications are starting to pop up-the most concerning being diabetes mellitus or sugar diabetes.

A new study released in the December issue of the medical journal Pediatrics showed a four-fold increased risk of diabetes among children exposed to atypical antipsychotics and a little less in those treated with antidepressants. While the study doesn’t well-define the exact number of children, who develop diabetes as a result of exposure to these drugs, it does highlight our need to watch these children closely for weight gain and signs of diabetes.

The most common antipsychotics and antidepressants I see used in treating behavior problems in both ADHD children and those who are not ADHD include:

  • Aripiprazole or Abilify
  • Clozapine or Clozaril
  • Olanzapine or Zyprexa
  • Quetiapine or Seroquel
  • Risperidone or Risperdal
  • Ziprasidone or Geodon
  • Paroxetine or Paxil
  • Fluoxetine or Prozac
  • Citalopram or Celexa
  • Sertraline or Zoloft
  • Duloxetine or Cymbalta

To protect your child from diabetes mellitus when they are taking an antidepressant or atypical antipsychotic:

  • Thoroughly discuss the use of these medications and the risk for side-effects with your child’s doctor before starting any medication
  • Be sure his or her blood sugar, blood chemistries, and hemoglobin A1C are tested before starting therapy (some of these drugs also cause problems with sodium and chloride-bicarbonate levels)
  • Discuss the need for any lifestyle changes your child will need make because of the medication-diet-exercise-weight control
  • Watch for excessive weight gain (more than 10% of pretreatment weight)
  • Keep an eye out for the subtle signs of diabetes; bed-wetting, increased thirst or urination, food cravings-especially sweets, fatigue, excessive sleepiness, skin sores that heal slowly or won’t heal-weight loss usually only occurs if diabetes is advanced
  • Have his or her blood glucose and hemoglobin A1C tested monthly for the first six months, as it’s often during the first six months that children, teens and adults are most likely to develop high blood sugars
  • Repeat blood glucose testing and hemoglobin A1C at least once every six months as long as they are taking the drug.

While it’s true that both antidepressants and antipsychotics have definite places in the treatment of depression, psychosis, and aggravated behavior disorders, we as parents and physicians must be diligent in watching for and preventing serious side effects of these mind-altering drugs.

In addition…ironically, diabetes suffered while taking antidepressants or antipsychotics might cause ADHD behavior resulting in the misdiagnosis of ADHD. The symptoms of diabetes mellitus can be mistaken for the symptoms of attention deficit hyperactivity disorder!

Dr. Frank

 

References:

Andrade SE, Lo JC, Roblin, Fouayzi H, Conner DF, Penfold RB, Chandra M, Reed G, and Gurwitz, JH. Antipsychotic medication use among children and risk of diabetes mellitus. Pediatrics. 2011 Dec;128(6):1135-41. Accessed March2012.

Geller, Barbara MD. Diabetes Risk Increased with Atypical antipsychotics in Children.  Journal Watch Psychiatry. Pediatrics and Adolescent Medicine. March 2012:Vol 2;3: 22.

ADHD Medication Side effects can cause ADHD Behavior

The possibility that ADHD medication might cause worsened behavior should be added to the many side effects of drugs used to treat ADHD.

Seventy-five percent of all children and teens treated for ADHD using an ADHD drug will experience a side-effect of the drug within the first month of therapy!

With that astounding number firmly in mind, please let me tell you about one of my patients; 9 year-old Clayton…

Clayton’s mom had noticed he wasn’t eating well and had lost seven pounds in two month’s (from 72 pounds to 65 pounds) on methylphenidate. He wasn’t complaining of a stomachache or nausea and certainly wasn’t vomiting, but he had lost his appetite. He said he just wasn’t hungry.

Clayton had been on the same dose of methylphenidate for 7 months and was doing great. His grades were up, his teachers were happy with his behavior and he had a best friend now-a girlfriend.

As far as his mom was concerned, nothing had changed in the way he took his pills, wasn’t taking any other medications, and nothing bad had happened in his life. He just suddenly lost his appetite and when he did, his behavior went south with it. Clayton was once again fidgeting in class, interrupting more, he was irritable, and his grades were going down.

How did we fix all of this?

I lowered his methylphenidate dose by about 20%, asked his mom to be sure he ate breakfast before taking his pills, and suggested she offer him a high protein snack as soon as he got home from school and before bed.

Within a month, Clayton’s weight was back up, his behavior was better and his grades had improved. Clayton’s worsened behavior was actually being caused by the very medications he was taking for his behavior-stimulant drugs for ADHD.

It’s not unusual see children who have lost 10 to 15 pounds on ADHD medications before anything was done to stop their weight loss. If your ADHD child or teen are overweight-it won’t be such a big deal. Maybe they need to lose a few pounds so their self-esteem will improve as the way their body looks gets better.

However, if your ADHD behavior problem child or teen isn’t overweight or is actually skinny for his or her size and age, then any weight loss might be dangerous. In fact, if a child were to suddenly lose 20% of his or her total body weight, doing so could damage their heart, muscles and kidneys.

Parents learn rapidly about all of the side effects of medications used to treat ADHD, because so many kids will suffer one of the many side effects in the first month. Common side effects of ADHD drugs include:

  • Headache and vision problems
  • Nausea, vomiting and abdominal pain or discomfort
  • Irritability and an increase in hyperactivity and impulsive behavior
  • Loss of appetite with or without weight loss
  • Fatigue and excessive sleepiness
  • Problems sleeping
  • Irregular or rapid heartbeat.

The real key to managing a child’s or teen’s ADHD medication lies in making sure they suffer the fewest side effects of whatever therapy is used, while getting the best behavior-learning benefits possible.

A parent can help their child with ADHD avoid worsened ADHD behavior caused by medications by making sure their child:

  • Eats something before taking their medications. The upset stomach and loss of appetite caused by ADHD drugs usually occurs when they are taken on an empty stomach.
  • Doesn’t take his or her pills with other medications that may not mix well.
  • Remembers to take their ADHD drugs at the same time every day without skipping days. Just skipping a couple of day’s medication can cause withdrawal symptoms with some ADHD stimulants.
  • Keeps his or her follow-up appointment with the doctor who started the medication so he learns about the side-effects of their ADHD drugs.

If you notice your child’s ADHD behavior is actually worsening with ADHD drug therapy, one of several things may be going on:

  • A side effect of the drug or drugs is causing his or her behavior to get worse
  • Your child may be on the wrong medication or receiving too high or too low of a dose
  • He or she may not really have ADHD. Instead, they may have one of the more than 70 things that can look just like and act just like ADHD.

If your ADHD child’s behavior changes for the worse despite being on medications that were previously working, you should consult his or her doctor and start looking for possible causes. By doing so, you just might prevent your ADHD child or teen from becoming a failure in life!

Dr. Frank

Drugs for Common Head Cold can Cause ADHD Behavior

Over the counter antihistamine-decongestant-cough medications can cause worsened ADHD behavior in both children and teens with ADHD and those who are not ADHD.

In the past eight weeks, I’ve seen no fewer than seven ADHD kids and teens with the impulsive-hyperactive type of ADHD whose ADHD medications had suddenly stopped working.  All seven were on non-stimulant ADHD drugs (guanfacine and clonidine) to help decrease their hyperactivity and help them control their impulsivity.

These kid’s and teen’s parents and teachers had noticed they often fell asleep in class in the early morning and later:

  • Were more fidgety-couldn’t sit still
  • Interrupted more than usual
  • Were restless
  • Didn’t sleep well (in two cases, they were having nightmares)
  • Were definitely more impulsive (one teen was caught speeding, when he normally drove well)
  • Were having problems concentrating well enough to get class work and homework done!

So, what caused ADHD children who had “more normal behavior” on prescription ADHD medications, to suddenly show an increase in symptoms of ADHD?

Non-prescription-over-the-counter cold medications…

In each case, we discovered the reason their ADHD medications seemed to stop working or weren’t working as well was due to over-the-counter antihistamine-decongestant-cough medications they were taking for head colds, cough, chest congestion and allergies.

Once the cold medications were stopped, all seven children’s ADHD behavior improved and returned to that of previous, adequate treatment levels.

Antihistamine-decongestant medications can interfere with the way ADHD medications work!

Here’s what happens…

Our sympathetic nervous system is the one that kicks in when we need a rush of adrenaline-our fight or flight reflex. When an ADHD child’s sympathetic nervous system is in overdrive, he or she will be much more impulsive, more hyperactive and as a result, suffer poor concentration and have poor attention to detail.

We think clonidine or guanfacine helps children with ADHD behavior-hyperactivity and impulsivity-by decreasing sympathetic output from the central (brain) and peripheral (everything outside of the brain) nervous system. The exact way these drugs do so is unknown, but research continues on this very important topic.

When an ADHD child with behavior problems is given an antihistamine-decongestant for a head cold, cough, allergy, or chest congestion, one of a couple of things may happen:

  1. If the drug contains alcohol or anything that causes sedation or sleepiness, it enhances the effects of the ADHD drug and causes too deep of a bedtime sleep, which carries over to the next morning and is often followed by a hang-over. Examples include: diphenhydramine, clemastine, and brompheniramine.Once the hang-over sedation wears off, a rebound occurs with an increase in irritability, hyperactivity and impulsiveness. That’s what happened in five of the seven children I mentioned above.
  2. If the drug contains a stimulant type decongestant such as pseudoephedrine or oxymetazoline, it’s sort of like mixing water with gasoline. Just like excessive caffeine, these drugs cause problems sleeping, restlessness, and if used excessively, irritability, hyper-ness and even rapid-skipping heart beat and elevated blood pressure. Essentially, mixing decongestants that increase sympathetic output (hyper-awake states) from the brain reverses the calming effects produced by ADHD drugs such as clonidine and guanfacine, thus providing an opportunity for impulsivity and hyperactivity to recur.That’s exactly what happened in the other two patients we discussed earlier. They were using nasal sprays containing oxymetazoline several times a day to improve nasal stuffiness and drainage. Once again, after the nasal decongestants were stopped, the teen’s ADHD behavior returned to baseline within three days.

You can avoid causing an increase in ADHD behavior symptoms in your ADHD child, teen or adult by:

  • Using non-sedating antihistamines such as loratadine, fexofenadine, or cetirizine
  • Avoiding use of nasal decongestants for more than two or three days or using saline nasal spray in their place
  • Avoiding the use of any cold or cough preparation that contains alcohol or caffeine.

Before closing, I’d like to remind you that over-use of any sedating antihistamine or stimulating decongestant can cause a child or teen to act just like they have ADHD, thus causing ADHD misdiagnosis. You can discover many more things that can confuse the diagnosis of behavior problems and cause the misdiagnosis of ADHD in Mistaken for ADHD.

Dr. Frank