Guide to Psychiatric Medications for Children and Adolescents

http://www.aboutourkids.org/articles/guide_psychiatric_medications_children_adolescents

Guide to Psychiatric Medications for Children and Adolescents

by Glenn S. Hirsch, MD

The following guide 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. This guide 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.

Class: Stimulants

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.
MEDICATION NAME		NOTES
Brand Name	Generic Name**
Ritalin Focalin Methylin Methylin Chewable Methylin Liquid	methylphenidate	These are short acting—generally lasting about 3–4 hours.
Concerta Focalin XR Metadate CD Ritalin LA Daytrana Patch	methylphenidate	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	amphetamine	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).
Adderall XR	amphetamine salts	Lasts 8–10 hours
Dexedrine Spansules	amphetamine	Lasts 8–10 hours

Class: Non-Stimulant (Selective Norepinephrine Reuptake Inhibitor)

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.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Strattera	atomoxetine	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.

Class: Antihypertensive

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. Side Effects: Dry mouth, sedation, dizziness. Rarely can trigger depressive symptoms.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Tenex	guanfacine	The TTS is a patch that is changed every 3–4 days. It may cause local irritation.
Catapres, Catapres TTS patch	clonidine

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.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Prozac Serefam	fluoxetine	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.
Zoloft	sertraline
Luvox	fluvoxamine
Paxil Paxil Cr Pexeva	paroxetine
Celexa	citalopram
Lexapro	escitalopram

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.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Tofranil	imipramine	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.
Norpramin	desipramine
Elavil	amitryptyline
Pamelor	nortriptyline
Sinequan	doxepin
Anafranil	clomipramine	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.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Wellbutrin Wellbutrin SR Wellbutrin XL	bupropion	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.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Effexor	venlafaxine	Has occasionally been used to treat ADHD especially in adults.
Effexor XR	venlafaxine	Long acting version of Effexor.
Remeron	mirtazapine
Cymbalta	duloxetine	This medication has both elements of both the SRI and the tricyclic antidepressants.

Class: MAOIs (monoamine oxidase inhibitors)

Benefits: Used to treat treatment-resistant depression and anxiety. Side Effects: Dizziness, sedation gastrointestinal symptoms, low blood pressure, changes in appetite and weight.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Nardil	phenelzine	These medications are rarely used in children and adolescents. Tyramine, an amino acid in some foods can interact with these medications to trigger severe high blood pressure. People taking them must follow a restricted diet (Emsam at lower doses does not require the diet).
Parnate	tranylcypromine
Emsam patch	selegiline

Class: Antipsychotics (sometimes called Neuroleptics)

Benefits: Treats psychosis, schizophrenia, bipolar disorder and aggression. Orap and Haldol are used to treat Tourette Disorder. Has been used to treat behavioral symptoms of Autism. Side Effects: Dizziness, sedation, dry mouth, constipation, blurred vision, increased appetite, restlessness, muscle stiffness. Prolonged use may result in a movement disorder called tardive dyskinesia.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Haldol	haloperidol	With the introduction of newer antipsychotics these medications are used much less frequently. This is only a partial list of the medications in this class.
Orap	pimozide
Prolixin	fluphenazine
Mellaril	thioridazine
Thorazine	chlorpromazine
Stelazine	trifluoperazine
Moban	molindone
Loxitane	loxapine

Class: Second generation (atypical) antipsychotics

Benefits: Treats psychotic conditions such as schizophrenia, can be useful in helping stabilize mood in bipolar disorder and in impulsive/aggressive behavior. Side Effects: Weight gain, sedation, dizziness, insulin resistance, muscle stiffness.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Risperdal	risperidone	Has been studied in the treatment of aggression and irritability in Autism.
Zyprexa	olanzapine
Seroquel	quetiapine
Geodon	ziprasidone
Abilify	aripiprazole
Clozaril	clozapine	May be the most effective medication in treatment resistant psychotic conditions. Must get weekly blood tests to monitor for a rare side effect that can depress the formation of blood cells.

Class: Anxiolytic (benxodiazepine)

Benefits: Reduces panic anxiety symptoms. Generally used for short term treatment. Side Effects: Sedation, dizziness.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Xanax Xanax XR	alprazolam	Can cause paradoxical hyperexcitability especially in young children. Is occasionally used for the treatment of mania. Often works immediately.
Klonopin	clonazepam
Ativan	lorazepam

Class: Anxiolytics

Benefits: Used for the treatment of general anxiety symptoms—not helpful for separation anxiety or social phobia. Side Effects: Dizziness, nausea, sedation.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Buspar	buspirone	Often takes several weeks to work.

Class: Hypnotics (sleep)

Benefits: Enhances sleep onset and quality of sleep. Side Effects: Dizziness, can cause paradoxical hyperexcitability especially in young children.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Ambien Ambien CR	zolpidem	These medications are generally not used as a first line treatment of insomnia. Understanding and dealing with the underlying issues that are disrupting sleep is always the first step.
Lunesta	eszopiclone
Sonata	zaleplon
Rozerem	ramelteon

Class: Mood Stabilizers

Benefits: Treats the symptoms of bipolar disorder. Side Effects: Excessive thirst, frequent urination gastrointestinal symptoms, acne, weight gain.