This article has been cited by other articles in PMC. Abstract Background To describe the rates, indications, and adverse effects of psychotropic drug prescription in a specialist tertiary hospital child and adolescent eating disorder service. Common indications were depressed mood, agitation, anxiety, and insomnia. Patient clinical severity and complexity was associated with prescribing.
Recently, these illnesses have been better documented and fully recognized in childhood and adolescence. An increase in prescribing rates of stimulants, antidepressants, clonidine, and antipsychotics in preschoolers has been observed.
Diagnosing a mental disorder in children, especially preschool children, can be difficult. Comorbidities are common and may complicate management, requiring polypharmacy, although many of the illnesses can be transient or may be adequately managed with cognitive behavioral therapy CBT alone to improve deficits in daily functioning.
However, these medications should be recommended judiciously, particularly if it is an off-label indication, at the lowest possible doses, to reduce side-effect potential. To complicate matters further, children are in a constant state of rapid change physically, cognitively, and emotionally, throughout their developmental years.
Physicians should heed this fact when selecting psychotropic medication sas it may affect adherence to the regimen. Often, the dosage and indication for psychotropic medications are based on extrapolated adult data, which are not always appropriate for very young children, school-age prepubertal children, or adolescents.
Some toxicities in adults have yet to be discovered in children. Furthermore, long-term consequences from administration of psychotropic medications at a young age, especially on the brain, are unknown. The bottom line is that more epidemiologic and clinical research is needed.
Childhood depression is among the most prevalent of pediatric mood disorders and is a leading cause of morbidity and mortality in children. Although major depressive disorder MDDthe most severe form of depression, has not been consistently linked to suicide, it remains an important contributor to suicidal behavior and suicide.
Fluoxetine, a selective serotonin reuptake inhibitor SSRIis recommended as first-line therapy initially at 10 to 20 mg every 24 hours for children ages 8 to 18 years.
Other reasons for switching medications include intolerance, comorbid diseases, potential drug interactions, and drug formulation. Close monitoring for suicidal ideation, at least during the first month following drug initiation, is strongly recommended.
Notably, limited data exist on the safety and efficacy of antidepressants and mood stabilizers in school-age prepubertal children. Eating disorders usually develop during adolescence but can also occur in early childhood.
They can coexist with depression, substance abuse, and anxiety disorders. Females are more likely to suffer from an eating disorder than are males. Nonpharmacologic treatment is recommended to restore weight lost. Established weight gain is followed by SSRI treatment for weight maintenance and resolution of mood and anxiety symptoms.
Fluoxetine is the only SSRI approved for reducing symptoms of bulimia nervosa. Notable side effects with antidepressants include sedation, especially the tricyclic antidepressants TCAs trazadone, mirtazapine, and nefazodone. While most SSRIs cause insomnia, paroxetine may induce mild sedation.
SSRIs may also cause declines in daytime and driving performance and increase potential for involvement in motor vehicle accidents.
Serum electrolytes should be checked if patients taking SSRIs present with unexplained mental slowing, somnolence, reduced food intake, vomiting, or seizures. None of the odds ratios for suicide-related events was statistically significant. In Septembera causal link was established between the newer antidepressants used for MDDs.
Subsequently in Octoberthe FDA mandated changes in antidepressant advertisements, package inserts, and information sheets to include a black box warning about the increased risk of suicidality. Children and adolescents with bipolar disorder often present with severe mood swings, disruptive behaviors, short sleep periods, intrusiveness, and hypersexuality.
Lithium is FDA approved for the treatment of acute mania and bipolar disorder in adolescents or children ages 12 to 18especially if the patient presents with classic euphoric mania without psychotic symptoms.
Common side effects are hypothyroidism, nausea, polyuria, polydipsia, tremor, acne, and weight gain. The latter two side effects may be not be well tolerated by adolescents; thus, compliance may become an issue. Monitoring of serum lithium levels and renal and thyroid function are recommended at baseline and every six months.
Sodium divalproex is widely used in children and adolescents with bipolar depression and aggressive behavior, but few controlled trials have been conducted.
Common side effects include weight gain, nausea, sedation, and tremor. Until the risk of polycystic ovary disease is clearly defined, weight or menstrual abnormalities, hirsutism, and acne should be monitored.
Females should also avoid pregnancy, since the drug is teratogenic. The dose should be titrated slowly, and frequent monitoring of serum concentrations is necessary if patients are concurrently taking other medications that affect the CYP system.
It also is a CYP enzyme inducer. Side effects include aplastic anemia, severe dermatologic reactions e. Females taking oral contraceptives should be counseled about using an additional mode of contraception or abstinence. Atypical antipsychotics provide a broader spectrum of efficacy with a better safety profile than the older antipsychotics and are preferred in practice.
The atypical agents block dopamine2 neurotransmission and increase serotonin levels.Health Essays. Search to find a specific health essay or browse from the list below: Psychotropics in Paediatrics or Adolescents. Co-prescription was rare: 4, children and adolescents (94% of the treated youths) received only one class of psychotropic medication, children and adolescents (6%) received drugs from two classes (mainly antidepressants and antipsychotics) and only 6 .
Paediatrics and adolescents with psychotic disorders will classically be put on psychotropic drugs while those with other disorders will be put on non-pharmacological treatment. Sometimes, both approaches may be used simultaneously.
Psychotropic drug prescribing in an Australian specialist child and adolescent eating disorder service: a retrospective study.
We propose some principles to guide prescription of psychotropics for children and adolescents with eating disorders (Table 5). Five atypical antipsychotics currently have includes children and adolescents.
FDA-approved indications for use in children and adolescents: aripiprazole, olanzapine, paliperidone, quetiapine, and risperidone.
The most frequently prescribed drug class was psychotropics, prescribed for % of patients with developmental-behavioural/mental health (DB/MH) diagnoses in and % in (P = ).