Overview of Psychiatric Medications in Children and Adolescents
By Scott Moreland, D.O.
The following overview includes most of the medications used to treat child and adolescent mental disorders. It lists the problems each medication might treat and some of the common side effects.Many of the mediations listed are not FDA-approved in children and adolescents but are used off-label*** with varying amounts of evidence supporting their use.This overview is intended to be informative and useful, but it is not comprehensive. Children should take these medications only under the careful supervision of their physicians.
Listed are only those adverse effects that occur more commonly and those that are rare but potentially serious. Always alert your physician about any other medications, over the counter pill and 'alternative treatments' that you may be taking.
Benefits: Treats the core symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) including, impulsivity, hyperactivity and inattention. There is very little documented difference in the effectiveness between the amphetamine and methylphenidate medicines. However, some children respond to one group better than another. Side Effects: Loss of appetite, difficulty falling asleep, irritability and /or moodiness. Some children may develop tics while on the medicine while those with a tic disorder may find that the tics worsen. Both growth and weight should be monitored, since weight loss can occur, and there is some evidence that stimulants may cause a slowdown in growth. Very rarely they may cause hallucinations or exacerbate manic symptoms These medications can increase blood pressure and pulse slightly. Please tell your doctor if there are any relatives with a history of heart disease at an early age.
These are short acting—generally lasting about 3–4 hours requiring multiple doses a day.Can also be given just in the afternoon as long-acting preparation is wearing off to extend coverage time after school for homework or extra-curricular activities.
Concerta Focalin XR Metadate CD Ritalin LA Daytrana Patch
These are long acting—generally lasting about 8–12 hours. Each one is formulated somewhat differently but there is generally no way to determine which will last the longest for any individual. Daytrana is the newest and uses a patch to deliver methylphenidate through the skin. The patch may cause some skin irritation.
Dexedrine Dextrostat Adderall
These are short acting—generally lasting about 3–6 hours. Each one is formulated somewhat differently but there is generally no way to determine which will last the longest for any individual. Adderall is a mixture of different forms of amphetamine (amphetamine salts).
Benefits: Treats the core symptoms of ADHD. May not have as robust an effect on symptoms as the stimulants but may help individuals who have anxiety along with their ADHD. Side Effects: Decreased appetite, nausea, insomnia or tiredness, dry mouth.
Has the potential to last 24 hours. Can often be given just once a day although some patients require a second dose in the late afternoon. Unlike most medications this one is dosed based upon the patient's weight.
Benefits: Historically used for the control of high blood pressure. Often used as a first medical treatment for the tics of Tourette Disorder. Can be useful in treating the hyperactive and impulsive symptoms of ADHD. Can sometimes help with children who have aggressive behaviors. Generally not useful for the inattentive symptoms. Recently released 24-hour preparation, Intuniv. Side Effects: Dry mouth, sedation, dizziness. Rarely can trigger depressive symptoms.
The TTS is a patch that is changed every 3–4 days. It may cause local irritation.Until recently, these 2 preparations had to be dosed 3-4 times a day. Clonidine is sometimes used at night as a sleep aid.
Catapres, Catapres TTS patch
Long acting form of tenex. Given once a day in the morning.
Class: SSRIs or SRIs (specific serotonin reuptake inhibitors)
Benefits: Useful for depression, obsessive-compulsive disorder and anxiety disorders. Side Effects: Appetite changes, nausea, headache, sweating, insomnia and occasionally tiredness, delayed ejaculation, decreased sexual desire.
Prozac was the first of this group of medications to be approved by the FDA. While there are some minor differences between these medications, they share more similarities than differences.
As a group they affect the neurotransmitter Serotonin.
In rare situations, during the early phases of the treatment for depression some individuals can have the onset or increase in suicidal thinking; therefore your physician will have guidelines on how frequently he needs to see the patient.
Paxil Paxil Cr Pexeva
Class: Tricyclic Antidepressants
Benefits: This group has been used to treat depression, ADHD, enuresis and chronic pain. Unlike the other tricyclics, Anafranil is used to treat OCD. Side Effects: Sedation, weight gain, nausea, dry mouth, constipation. May cause changes in heart rhythm.
This group of medications is now rarely used for the treatment of depression or ADHD. The SRI's have generally replaced them for the treatment of depression and Strattera has replaced them for the treatment of ADHD.
As a group they have effects mainly on the neurotransmitter norepinephrine and less so on serotonin.
Sometimes used in treatment resistant depression and/or OCD.
This was the first medication approved in the U.S. for the treatment of OCD. Sometimes used to augment the SRIs.
Class: Other Antidepressants
Benefits: For depression. Used for the treatment of smoking cessation (under the name Zyban) Has been used to treat symptoms of ADHD. Generally not useful for anxiety disorders. Side Effects: dry mouth, decreased appetite. At high dose may increase susceptibility to a seizure.
Wellbutrin Wellbutrin SR Wellbutrin XL
Bupropion looks chemically similar to the amphetamines.
CLASS: Other Antidepressants
Benefits: Treats depression. May be helpful in anxiety. Some studies suggest that they can be helpful for depression where physical complaints (e.g. headaches, general pain) are a dominant feature. Side Effects: Generally similar to the SSRI group. Remeron and Cymbalta tend to be sedating.
Has occasionally been used to treat ADHD especially in adults.
Long acting version of Effexor.
This medication has both elements of both the SRI and the tricyclic antidepressants.