Medication, Children, and Mental Disorders

Using medication for children with mental health disorders remains a controversial issue. They may be prescribed for young children when the potential benefits outweigh the risks and side effects of the medication.

If your young child is being prescribed psychotropic drugs, be sure to work very closely with your doctor. Learn everything you can about the drugs prescribed for your child, including potential side effects. Learn which side effects are tolerable and which ones are threatening. In addition, learn and keep in mind the goals of a particular treatment (e.g., change in specific behaviors).

Medication should not be the only form of treatment, but used in concert with other treatments, such as Occupational Therapy (OT), or behavioral therapy. Proper dosages in medication approved by the FDA for children depend on body weight and age. Combining multiple psychotropic medications should be avoided in very young children unless absolutely necessary.

Major Categories of Medications

There are several major categories of medications used for childhood mental disorders: stimulants, depressants, antianxiety, antipsychotic, and mood stabilizers. The explanation of each of these categories and the list approved by the FDA for children below are from the National Institute of Mental Health (NIMH).

• Stimulant: There are four stimulants that are approved for use in the treatment of attention deficit hyperactivity disorder (ADHD), the most common behavioral disorder of childhood. These medications have all been extensively studied and are specifically labeled for pediatric use. Children with ADHD exhibit such symptoms as short attention span, excessive activity, and impulsivity that cause substantial impairment in functioning. Stimulant medication should be prescribed only after a careful evaluation to establish the diagnosis of ADHD and to rule out other disorders or conditions. Medication treatment should be administered and monitored in the context of the overall needs of the child and family, and consideration should be given to combining it with behavioral therapy. If the child is of school age, collaboration with teachers is essential.

• Antidepressant and Antianxiety: These follow the stimulant medications in prevalence among children and adolescents. They are used for depression, a disorder recognized only in the last twenty years as a problem for children, and for anxiety disorders, including obsessive-compulsive disorder (OCD). The medications most widely prescribed for these disorders are the selective serotonin reuptake inhibitors (the SSRIs). In the human brain, there are many “neurotransmitters” that affect the way we think, feel, and act. Three of these neurotransmitters that antidepressants influence are serotonin, dopamine, and norepinephrine. SSRIs affect mainly serotonin and have been found to be effective in treating depression and anxiety without as many side effects as some older antidepressants.

• Antipsychotic: These are used to treat children with schizophrenia, bipolar disorder, autism, Tourette’s syndrome, and severe conduct disorders. Some of the older antipsychotic medications have specific indications and dose guide- lines for children. Some of the newer “atypical” antipsychotics, which have fewer side effects, are also being used for children. Such use requires close monitoring for side effects.

• Mood Stabilizing: These are used to treat bipolar disorder (manic-depressive illness). However, because there is very limited data on the safety and efficacy of most mood stabilizers in youth, treatment of children and adolescents is based mainly on experience with adults. The most typically used mood stabilizers are lithium and valproate (Depakote®), which are often very effective for controlling mania and preventing recurrences of manic and depressive episodes in adults. Research on the effectiveness of these and other medications in children and adolescents with bipolar disorder is ongoing. In addition, studies are investigating various forms of psychotherapy, including cognitive-behavioral therapy, to complement medication treatment for this illness in young people.

Effective treatment depends on appropriate diagnosis of bipolar disorder in children and adolescents. There is some evidence that using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer. In addition, using stimulant drugs to treat co- occurring ADHD or ADHD-like symptoms in a child with bipolar disorder may worsen manic symptoms. While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder. If manic symptoms develop or markedly worsen during anti- depressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.

FDA Approved Medications for Children

Medications Chart

The following are approved by the FDA (Food and Drug Administration) for use in children with emotional disorders:

Stimulant Medications

Brand Name Adderall with the Generic Name: amphetamines is approved for age 3 and older

Brand Name Concerta with Generic Name of methylphenidate is approved for ages 6 and older

Brand Name Cylert* with Generic Name of pemoline is approved for ages 6 and older

Brand Name Dexedrine with Generic Name of dextroamphetamine is approved for ages 3 and older

Brand Name Dextrostat with Generic Name of dextroamphetamine is approved for ages 3 and older

Brand Name Ritalin with Generic Name of methylphenidate is approved for ages 6 and older

* Due to its potential for serious side effects affecting the liver, Cylert should not ordinarily be considered as first line drug therapy for ADHD.

Antidepressant and Antianxiety Medications

Brand Name Anafranil Generic Name clomipramine is approved for ages 10 and older (for OCD)

Brand Name BuSpar Generic Name buspirone is approved for ages 18 and older

Brand Name Effexor Generic Name venlafaxine is approved for ages 18 and older

Brand Name Luvox (SSRI)Generic Name fluvoxamine is approved for ages 8 and older (for OCD)

Brand Name Paxil (SSRI)Generic Name paroxetine is approved for ages 18 and older

Brand Name Prozac (SSRI)Generic Name fluoxetine is approved for ages 18 and older

Brand Name Serzone (SSRI)Generic Name nefazodone 18 and older

Brand Name Sinequan Generic Name doxepin is approved for ages 12 and older

Brand Name Tofranil Generic Name imipramine is approved for ages 6 and older (for bed-wetting)

Brand NameWellbutrin Generic Name bupropion is approved for ages 18 and older

Brand Name Zoloft (SSRI)Generic Name sertraline is approved for ages 6 and older (for OCD)

Antipsychotic Medications

Brand Name Clozaril (atypical) with Generic Name clozapine is approved for ages 18 and older

Brand Name Haldol with Generic Name haloperidol is approved for ages 3 and older

Brand Name Risperdal (atypical) with Generic Name risperidone is approved for ages 18 and older

Brand Name Seroquel (atypical) with Generic Name quetiapine is approved for ages 18 and older

(generic only) thioridazine is approved for ages 2 and older

Brand Name Zyprexa (atypical) with Generic Name olanzapine is approved for ages 18 and older

Brand Name Orap with Generic Name pimozide is approved for ages 12 and older (for Tourette’s syndrome). Data for age 2 and older indicate similar safety profile.

Mood Stabilizing Medications

Approved AgeBrand Name Cibalith-S with Generic Namelithium citrate Approved Age 12 and older

Brand Name Depakote with Generic Name divalproex sodium Approved Age 2 and older (for seizures)

Brand Name Eskalith with Generic Name lithium carbonate Approved Age 12 and older

Brand Name Lithobid with Generic Name lithium carbonate Approved Age 12 and older

Brand Name Tegretol with Generic Name carbamazepine Approved Age any age (for seizures)

Does it really matter if a medication has been approved for use in children or not? Well, the approval by the FDA means that particular medication has been tested to see if it is safe and actually gives the proper results for the specified age group. Approved drugs will also include information on the proper dosage, side effects, and what it has been approved to be used for. Off-label use means that a doctor is prescribing a medication to a child that has not been specifically approved by the FDA.

Things to keep in mind

Things to keep in mind (and ask your doctor about) are that FDA approval does not automatically show extensive research and clinical testing in children. There may be enough for the FDA to consider it safe to use, but not years of in-depth clinical studies. And likewise, just because it has not been approved by the FDA for specific use in children, does not mean there is no evidence at all that it can be used safely and effectively.

Medication, especially in young children, should only be used as a last resort. Discuss this with your doctor. Whether FDA approved or not, be sure to ask what is the justifying factor that outweighs the risk to your child. Or just simply ask on what evidence or study is the doctor basing his decision. Now THAT is a great conversation starter!

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