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

Stimulant Medications

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

Dextroamphetamine

• Dexedrine and Dextrostat

• Adderall and Adderall XR

Newest Class of ADHD Medications (Prodrug Stimulant)

• Lisdexamfetamine dimesylate (Vyvanse)

Other Medications to Treat Attention Deficit Hyperactivity Disorder

Nonstimulant Medications

• Atomoxetine (Strattera)• Guanfacine (Tenex, *Intuniv)

• Bupropion (Wellbutrin)• Clonidine (Catapres, *Kapvay)• Imipramine (Tofranil)

Antipsychotic Medications

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

*Paliperidone (Invega)

• FDA approved for the treatment of:

– Schizophrenia 12 to 17 years old

Clozapine (Clozaril)

• Gold standard for treating schizophrenia

• Two previous therapeutic trials

• Clozaril National Registry

• Labs each week X 6 months

Mood Stabilizers

Mood Stabilizers

• Lithium

• Anticonvulsants or AED

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)

AntidepressantMedications

The Opposite of Depression is….

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

Sertraline (Zoloft)

• FDA approved OCD 6 to 17 years old

• Scored tablets provide flexibility

Fluvoxamine (Luvox)

• FDA approved OCD 8 to 17 years old

• Generic fluvoxamine is available

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)

Duloxetine (Cymbalta)

• Relief of physical symptoms

• Do NOT use with a history of liver disease

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”

Resources

• ParentsMedGuide.org

• American Academy of Child and Adolescent Psychiatry