Transcript An Overview of Psychiatric Medications for Children and Adolesscents

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
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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
• Guanfacine
(Strattera)
(Tenex, *Intuniv)
• Bupropion
• Clonidine
• Imipramine
(Wellbutrin)
(Catapres, *Kapvay)
(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
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Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole
*Paliperidone
*Iloperidone
*Asenapine
*Lurasidone
(Clozaril)
(Risperdal)
(Zyprexa)
(Seroquel)
(Geodon)
(Abilify)
(Invega)
(Fanapt)
(Saphris)
(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
• Carbamazepine
(Depakote)
(Tegretol)
• Oxcarbazepine
• Gabapentin
• Topiramate
(Trileptal)
(Neurontin)
(Topamax)
Antidepressant
Medications
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
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Depression
OCD
ADHD
School Phobia
Bedwetting
Night Terrors
Not recommended
Clomipramine
Imipramine
Mixed Results
Amitriptyline/Imipramine
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
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Fluoxetine
Parosetine
Sertraline
Fluvoxamine
Citalopram
Escitalopram
*Vilazodone
(Prozac)
(Paxil)
(Zoloft)
(Luvox)
(Celexa)
(Lexapro)
(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
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Lexapro
Prozac
Zoloft
Fluvoxamine
Depression
Depression and OCD
OCD
OCD
Novel Antidepressants
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Bupropion
Mirtazapine
Venlafaxine
Desvenlafaxine
Duloxetine
Trazodone
(Wellbutrin, *Aplenzin)
(Remeron)
(Effexor)
(Pristiq)
(Cymbalta)
(*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