The information in this section is taken from non-copyrighted material on the Mental Health Institute Web Page.
While medication rarely should be the only strategy used, in some cases it may be a key component to effective treatment. If your child’s treatment provider believes that your child could benefit from medication, he/she will refer you to a psychiatrist or your primary care physician. Medications can only be recommended and prescribed by a medical doctor (MD). The decision to accept a doctor’s recommendation for medication can be difficult. Issues to be considered are the age of your child, severity of emotional and/or behavioral difficulties, level of life impairment, your child’s degree of cooperation and the potential benefit versus risk of the medication. As parents you will want to ask your child’s doctor many questions, research the medication(s) being recommended and carefully think over your final decision.
If you decide to place your child on medication, learn everything you can about it. Know which side effects are tolerable and which are life threatening. Have your child monitored regularly by the prescribing physician. Contact your doctor whenever you have any concerns about the presence of side effects or the medication’s effectiveness. Listed below is information describing the several major categories of psychotropic medications. It is intended to provide you with a general overview that can serve as a starting point for understanding and accessing additional information from your child’s treating physician/psychiatrist and other authoritative resources.
There are several major categories of psychotropic medications: stimulants, antidepressants, anti-anxiety agents, anti-psychotics and mood stabilizers. For medications approved by the FDA for use in children, dosages depend on body weight and age.
Stimulant Medications: There are four stimulant medications 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 often causes substantial behavioral, social and academic impairment. Stimulant medication should be prescribed only after a careful evaluation is performed 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 Anti-anxiety Medications: These medications 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 other antidepressants.
Anti-psychotic Medications: These medications are used to treat children with schizophrenia, bipolar disorder, autism, Tourette’s syndrome and severe conduct disorders. Some of the older anti-psychotic medications have specific indications and dosage guidelines for children. Some of the newer “atypical” anti-psychotics, that have fewer side effects, are also being used for children. Such use requires close monitoring for side effects.
Mood Stabilizing Medications: These medications 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 compliment 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 medications 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 antidepressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.
The following Medications Table (Table 2) below shows many of the commonly prescribed medications for children with mood, anxiety (including Obsessive Compulsive Disorder), disruptive behavior and thought disorders. It is intended to provide you with some psychopharmacological terminology that can help you access additional information from your treating medical doctor. It is important to note that it is common practice for doctors to prescribe medications to patients outside the approved age group (see section below titled “What Does Off Label Mean”). The reason for this is that physician experience and judgement is ahead of the research process. If your child is prescribed a medication that has not been approved for his/her age group, do not assume that the physician made an error in his/her selection. Instead, speak to the physician and find out the appropriateness and potential benefit of the medication plan being recommended.
Anti-Depressant and Anti-Anxiety Medications
Mood Stabilizing Medications
When your child is being evaluated and considered for psychotropic medication, it is essential that you provide the doctor with a thorough history of your child’s medical problems, any medications your child is taking, including over-the-counter medications or vitamin and herbal supplements, and any allergic reactions your child has suffered. If a medication is prescribed for your child, there are certain questions you should ask. It will be helpful to take notes as it is easy to forget exactly what the doctor says.
- What is the name of the medication and how will it help my child? Is the medicine available in both brand name and generic versions, and is it all right to use the less expensive (generic) medication? What is the name of the generic version? Is it all right to switch among brands, or between brand name and generic forms?
- What is the proper dosage for my child? Is the dose likely to change as he/she grows?
- What if my child has a problem with the pill or capsule? Is it available in a chewable tablet or liquid form?
- How many times a day must the medication be given? Should it be taken with meals, or on an empty stomach? Should the school give the medication during the day?
- How long must my child take this medication? If it is discontinued, should it be done all at once or slowly?
- Will my child be monitored while on this medication and, if so, by whom?
- Should my child have any laboratory tests before taking this medication? Will it be necessary to have blood levels checked or have other laboratory tests during the time my child is taking this medication?
- Should my child avoid certain foods, other medications, or activities while using this medication?
- Are there possible side effects? If I notice a side effect—such as unusual sleepiness, agitation, fatigue, and hand tremors—should I notify the doctor at once?
- What if my child misses a dose? Spits it up?
- How well established and accepted is the use of this medication in children or adolescents?
You may think of other questions. Don’t be afraid to ask. When you have the prescription filled, be sure the pharmacist gives you a flyer describing the medication, how it should be taken, and any possible side effects it may have. The label on the medication will have a lot of information. Read the label carefully before giving the medication to your child. The label will give the name of the pharmacy, its telephone number, the name of the medication, the dosage, and when it should be taken. It will also tell you how many times the medication can be refilled.
If you want to learn more about your child’s medication, you will find helpful books at your public library, or the reference librarian can show you how to look up the medication in the Physicians’ Desk Reference (PDR). Of course you can also access information from the Internet; however, much care is required in distinguishing fact from opinion.
WHAT DOES “OFF-LABEL” MEAN?
Based on clinical experience and medication knowledge, a physician may prescribe to young children a medication that has been approved by the U.S. Food and Drug Administration (FDA) for use in adults or older children. This use of the medication is called “off-label.” Most medications prescribed for child mental disorders, including many of the newer medications that are proving helpful, are prescribed off-label because only a few of them have been systematically studied for safety and efficacy in children. Medications that have not undergone such testing are dispensed with the statement that “safety and efficacy have not been established in pediatric patients.” The FDA has been urging that products be appropriately studied in children and has offered incentives to drug manufacturers to carry out such testing. The National Institutes of Health and the FDA are examining the issue of pharmacological research in children and are developing new research approaches.
HELPING YOUR CHILD TAKE MEDICATION SAFELY
- Be sure the doctor knows all medications—including over-the-counter medications and herbal and vitamin supplements—that your child takes.
- Read the label before opening the bottle. Make sure you are giving the proper dosage. If the medication is liquid, use a special measure—a cup, a medicine dropper, or a syringe. Often a measure comes with the medicine. If not, ask your pharmacist which measure is most suitable to use with the medication your child is taking.
- Always use child-resistant caps and store all medications in a safe place.
- Never decide to increase or decrease the dosage or stop the medication without consulting the doctor.
- Don’t give medication prescribed for one child to another child, even if both appear to have the same problem.
- Keep a chart and mark it each time the child takes the medication. It is easy to forget.