An Overview of Psychiatric Medications for Children and Adolesscents John Webber, M.D. Youth Home,...
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Transcript of An Overview of Psychiatric Medications for Children and Adolesscents John Webber, M.D. Youth Home,...
An Overview of Psychiatric Medications for Children and Adolesscents
John Webber, M.D.Youth Home, Inc.(501) 821-5500
Objectives
• The importance of child/teen mental health.• Principles of medication treatment• Comprehensive but not exhaustive overview
of psychiatric medications.• In-depth review of antidepressants• Provide time for questions and discussion.
Goals
• Add to your understanding of why medications are prescribed for children and teenagers.
• Adle to distinguish between antidepressants, stimulants, antipsychotics and anticonvulsants.
• Recognize brand and generic names in each class of psychiatric medications.
Housekeeping
• This presentation and your handout will follow the convention of listing the generic name followed by the brand name.
• For example, Sertraline (Zoloft)• *medications are newest
Normal Behavior
• Children– Imaginary friends– Events controlled by thoughts/feelings
• Teens– Moody and irritable– Oppositional and antisocial– Unique insights into the nature of reality
Medication Priniciples
• The full range of psychiatric medications are prescribed for children and teenagers.
• Several medications are used off-label.
• Medication is itself a therapeutic issue
Psychotropic Medications
• Stimulants• Other medications to treat ADHD• Antipsychotic medications• Mood Stabilizers• Antidepressants
Methylphenidate
• Ritalin is the best known example
• Includes Metadate, Methylin, Focalin
• Concerta is a longer-acting form of methylphenidate with a unique design
• Daytrana is a transdermal patch
Nonstimulant Medications
• Atomoxetine (Strattera)• Guanfacine (Tenex, *Intuniv)
• Bupropion (Wellbutrin)• Clonidine (Catapres, *Kapvay)• Imipramine (Tofranil)
Antipsychotics
• Psychotic disorders
• Bipolar disorder
• Irritability associated with autism
• Severely agitated/violent behaviors
Antipsychotic Medications
• Typical or Conventional or 1st generation
• Atypical or Novel or 2nd generation
Typical/Conventional/1st Generation
• Haloperidol (Haldol)
• Pimozide (Orap)
• Chlorpromazine (Thorazine)
• Thioridazine (Mellaril)
Atypical/Novel/2nd Generation
• Clozapine (Clozaril)• Risperidone (Risperdal)• Olanzapine (Zyprexa)• Quetiapine (Seroquel)• Ziprasidone (Geodon)• Aripiprazole (Abilify)• *Paliperidone (Invega)• *Iloperidone (Fanapt)• *Asenapine (Saphris)• *Lurasidone (Latuda)
Aripiprazole (Abilify)
• FDA approved for the treatment of:
– Autism (Irritability) 6 to 17 years old
– Bipolar Disorder 10 to 17 years old
– Schizophrenia 13 to 17 years old
Quetiapine (Seroquel, Seroquel XR)
• FDA approved for the treatment of:
– Bipolar Disorder 10 to 17 years old
– Schizophrenia 13 to 17 years old
• Seroquel XR not approved < 18 years old
Risperidone (Risperdal)
• FDA approved for the treatment of:
– Autism (Irritability) 5 to 16 years old
– Bipolar Disorder 10 to 17 years old
– Schizophrenia 13 to 17 years old
Olanzapine (Zyprexa)
• FDA approved for the treatment of:
– Bipolar Disorder 13 to 17 years old
– Schizophrenia 13 to 17 years old
Clozapine (Clozaril)
• Gold standard for treating schizophrenia
• Two previous therapeutic trials
• Clozaril National Registry
• Labs each week X 6 months
Lithium (Eskalith, Lithobid)
• Effective in treating manic symptoms
• Used in combination with other medications to treat resistant depression
• Protects against suicidal behavior
• “Lost” medication
Anticonvulsants/AED
• Divalproex Sodium (Depakote)• Carbamazepine (Tegretol)
• Oxcarbazepine (Trileptal)• Gabapentin (Neurontin)• Topiramate (Topamax)
Classes of Antidepressant
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors
• Novel Antidepressant
Tricyclic Antidepressants
• Amitriptyline (Elavil)
• Imipramine (Tofranil)
• Clomipramine (Anafranil)
Tricyclics
• Depression Not recommended• OCD Clomipramine• ADHD Imipramine• School Phobia Mixed Results• Bedwetting Amitriptyline/
Imipramine• Night Terrors Imipramine
Selective Serotonin Reuptake Inhibitors (SSRIs)
• Preferred medications for treating child and adolescent depression
• First line treatment for GAD, OCD, PTSD, and panic disorder
Selective Serotonin Reuptake Inhibitors
• Fluoxetine (Prozac)• Parosetine (Paxil)• Sertraline (Zoloft)• Fluvoxamine (Luvox)• Citalopram (Celexa)• Escitalopram (Lexapro)• *Vilazodone (Vibryd)
Fluoxetine (Prozac)
• First SSRI in the United States (1987)
• FDA approved MDD 8 to 18 years old
• FDA approved OCD 7 to 17 years old
• Long-acting so useful in noncompliance
Escitalopram (Lexapro)
• FDA approved MDD 12 to 17 years old
• Don’t need much– 10 mg. is about the same as 40 mg. Celexa
SSRI Summary
• SSRIs preferred in child/teen depression
• Lexapro Depression• Prozac Depression and OCD• Zoloft OCD• Fluvoxamine OCD
Novel Antidepressants
• Bupropion (Wellbutrin, *Aplenzin)• Mirtazapine (Remeron)• Venlafaxine (Effexor)• Desvenlafaxine (Pristiq)• Duloxetine (Cymbalta)• Trazodone (*Oleptro)
Buproprion (Wellbutrin, Wellbutrin SR, Wellbutrin XL, *Aplenzin
• Option for Depression + ADHD
• Should not be used with a history of eating disorder or seizures
• Bupropion is a treatment for smoking
Mirtazapine (Remeron)
• Complex mechanism of action involving multiple neurotransmitter systems
• Rapid onset of action in adults
• Sedating so prescribed at bedtime
• Good choice for “anxious” depression
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Venlafaxine (Effexor)
• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)
Venlafaxine (Effexor, Effexor XR)
• Not recommended due to side effects (increased diastolic blood pressure, increased pulse, dermatological)
Conclusions
• Children/teens can and do have serious mental illness including Major Depression, Bipolar Disorder, and Schizophrenia
• The full range of psychiatric medications are prescribed to those < 18 years of age
• Medication is only one part of treatment• Many new medications are actually “old wine
in new bottles”