CHILDREN, MENTAL ILLNESS & MEDICATIONS
"Medications...should be used as part of a
comprehensive treatment plan"
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In the US, one in five children and adolescents suffer from mental illness at any given
time. Most do not get the help they need. If left untreated, these children have increased
risks of school failure and drop out, drug abuse, and many other difficulties, many of which
can be prevented or greatly lessened by timely evaluation and appropriate treatment. A key
is for parents to recognize the problem and seek appropriate diagnosis and treatment. As
with other illnesses, mental disorders have specific diagnostic criteria and treatment
options. A complete evaluation by a child psychiatrist is important. This paper is an
overview of the medications most commonly used to treat childhood mental disorders as part
of a comprehensive treatment plan.
DIAGNOSIS
Medications...should be used as part of a comprehensive treatment plan. Diagnosis
must precede prescription of medications. It is based on a collaborative process that should
involve psychiatric and other physicians, the child, the child's family, and school-based or
other appropriate clinicians. Assessment is designed to reach a comprehensive diagnosis
after a thorough evaluation of psychiatric, social, cognitive, educational, and
medical/neurological factors.
TREATMENT
Following diagnosis, psychiatrists develop a comprehensive treatment plan that encompasses
relevant aspects of a child's life, taking into account coexisting medical conditions, the
child's needs and family and child preferences. For optimal outcomes, an informed,
multi-modal therapy specifically designed by a child (pediatric) psychiatrist for a specific
child is the most appropriate. Potential elements include family and school consultation,
medication, and various forms of therapy, such as cognitive-behavior therapy, psychotherapy,
parental and family therapy, social skills training, & group therapy. Medications,
prescribed by a psychiatrist or other well-trained physician, should not automatically be
the first choice in treatment, but should be used as part of a comprehensive treatment plan
when their benefits outweigh the risk.
Extensive information regarding the complete range of treatment options is available from
the American Psychiatric Association.
REVIEW OF MEDICATIONS
Stimulants
Stimulants, including Ritalin, Adderall, & Concerta, are by far the most widely
researched and commonly prescribed treatments for children with Attention-deficit/
hyperactivity disorder (ADHD). ADHD is more fully discussed in Vol 1, #1 of Psychiatry on
Call. They diminish motor overactivity and impulsive behaviors seen in ADHD and allow the
child to sustain attention and improve physical coordination. Stimulants can cause an
immediate and often dramatic improvement in behavior, cognition and judgment, both at school
and at home. In general, stimulants are regarded as an effective ADHD therapy with high
safety. Side effects are usually mild, short-term, dose-related and subject to individual
differences.
There has been some public concern about whether children taking stimulants for ADHD are
at increased risk for substance abuse. A 1999 study suggests the opposite, that such
medications may protect children with ADHD from future substance abuse.
Antidepressant and Antianxiety Medications
Depression tends to run in families. At least one study shows that more than 25% of
depressed children have a close relative with the disease. Early onset may predict more
severe illness in adult life, unless recognized and treated early in life. Depression in
children is often an underlying factor in decreased school performance, eating disorders,
headaches, sleep problems and other physical problems. There are many varieties of
antidepressants on the market. The Selective Serotonin Reuptake Inhibitors (SSRIs) such as
Prozac, Zoloft, Paxil, Celexa, & Luvox; the Serotonin Reuptake Inhibitors (SRIs) Serzone
and Effexor; and the atypical antidepressant Wellbutrin are the most commonly prescribed.
These agents appear safe and effective for the treatment of severe and persistent
depression. Wellbutrin and Effexor are also used to treat ADHD.
Children can also experience anxiety disorders, such as obsessive-compulsive disorders (OCD)
and panic attacks. For example, children can experience panic disorder and agoraphobia (e.g.,
extreme fear of leaving one's home). Children with anxiety disorders are most frequently
treated with SSRIs and psychotherapy. Other agents used to treat anxiety disorders include
BuSpar and Inderal.
Medications for Bipolar Disorder
Bipolar disorder (also known as "manic-depression") was until recently thought to
begin only in the late teens or early adulthood. However, recent studies reveal that this
illness can occur in younger children. Bipolar disorder is a neurobiological brain disorder
characterized by severe fluctuations in mood and activity level. It can present with
symptoms similar to ADHD. Since the treatments used for bipolar disorder and ADHD are quite
different, a comprehensive and thorough diagnostic evaluation is needed. Research suggests
that a genetic predisposition to bipolar disorder can be inherited. Mood stabilizers such as
Depakote, Tegretol, and lithium appear to be helpful, along with various forms of school
accommodations and psychotherapy for the child, multi-family psycho-education groups for the
child and family, and peer support for parents.
Antipsychotics
Antipsychotic medications have been used to treat childhood psychotic disorders and to
control agitation, aggression, and self-injurious behaviors in children with developmental
disabilities and pervasive developmental disorders (autism and autism-like disorders).
The principal psychotic illnesses that affect children are schizophrenia and bipolar
disorder, both chronic and disabling. Typically, these emerge in adolescence or early
adulthood, although research studies are revealing that cognitive and social impairments may
be evident earlier in children, and that they can onset in childhood and be successfully
treated. There are a number of antipsychotic medications available, including Geodon,
Risperdal, Seroquel, and Zyprexa. They generally yield comparable results. The main
differences are in the potency, the dosage (amount) prescribed to produce beneficial
effects, and the side effects. Older antipsychotics such as Haldol or Thorazine are used
infrequently.
Other Medications Clonidine is used to treat ADHD, anxiety disorders, sleep disturbances,
Tourette's syndrome and other tic disorders. Tenex also appears to have beneficial effects
on hyperactive behaviors, attention abilities, anxiety and tic disorders, and may be less
sedating.
OFF LABEL USE
Physicians may legally prescribe medications in ways not specifically approved by the Food
& Drug Administration. In fact, it is standard practice for physicians to do so, taking
into account new research findings, clinical experience, and the child's needs. Prescription
for "off-label" purposes of any medication should be made only after a
comprehensive evaluation has been made and other forms of therapy (or combination of) have
been considered, and must be monitored closely.
CONCLUSION
The American and California Psychiatric Associations share the desire of the National
Institute of Mental Health to ensure the appropriate treatment of mental illnesses in
children. Medications must be prescribed judiciously as part of a comprehensive treatment
plan and only after a thorough evaluation by qualified medical personnel. More funding is
needed for mental health services for children, and for further research to understand the
causes of illness and to develop more effective treatments for children.
Source: Adapted and updated from a fact sheet from the American Psychiatric
Association (APA) March, 2000. For the complete fact sheet, with bibliography, consult the APA's
web site.
Other useful web sites:
American Academy of Child and Adolescent
Psychiatry
National Institutes of Mental Health
U.S. Surgeon General
American Academy of Pediatrics
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