Initiating antipsychotic medications may elevate a child’s risk for type 2 diabetes by nearly 50%, according to the largest study to date on the risks of antipsychotics published April 6 online in JAMA Pediatrics. Among children who are also receiving antidepressant drugs, the risk may double. 

Lead author David Rubin, MD, MSCE, used national Medicaid data on more than 1.3 million children aged 10 to 18 years with a mental health diagnosis. Children enrolled in Medicaid are more likely than privately insured children to be prescribed antipsychotic medications, the authors noted.

The baseline risk for developing diabetes among children who were not exposed to antipsychotic drugs in the study was 1 in 400. This risk went up to 1 in 260 among those initiating antipsychotic therapy and to 1 in 200 among those who began taking antipsychotic medications while they were simultaneously receiving antidepressant drugs. 

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The authors recommended that clinicians and families periodically revisit the treatment strategy to address challenging behaviors and consider evidence-based counseling services such as trauma-focused cognitive therapy that could address underlying emotional trauma. Clinicians should also attempt to transition the child off antipsychotic treatment as soon as possible, once the behavioral issues are better addressed.