An Overview of Psychiatric Medications for Children and Adolesscents

1. An Overview of Psychiatric Medications for Children and Adolesscents John Webber, M.D. Youth Home, Inc. (501) 821-5500

2. 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.

3. 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.

4. 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

5. Normal Behavior • Children • Imaginary friends • Events controlled by thoughts/feelings • Teens • Moody and irritable • Oppositional and antisocial • Unique insights into the nature of reality

6. 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

7. Psychotropic Medications • Stimulants • Other medications to treat ADHD • Antipsychotic medications • Mood Stabilizers • Antidepressants

8. Stimulant Medications

9. 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

10. Dextroamphetamine • Dexedrine and Dextrostat • Adderall and Adderall XR

11. Newest Class of ADHD Medications (Prodrug Stimulant) • Lisdexamfetamine dimesylate (Vyvanse)

12. Other Medications to Treat Attention Deficit Hyperactivity Disorder

13. Nonstimulant Medications • Atomoxetine (Strattera) • Guanfacine (Tenex, *Intuniv) • Bupropion (Wellbutrin) • Clonidine (Catapres, *Kapvay) • Imipramine (Tofranil)

14. Antipsychotic Medications

15. Antipsychotics • Psychotic disorders • Bipolar disorder • Irritability associated with autism • Severely agitated/violent behaviors

16. Antipsychotic Medications • Typical or Conventional or 1st generation • Atypical or Novel or 2nd generation

17. Typical/Conventional/1st Generation • Haloperidol (Haldol) • Pimozide (Orap) • Chlorpromazine (Thorazine) • Thioridazine (Mellaril)

18. Atypical/Novel/2nd Generation • Clozapine (Clozaril) • Risperidone (Risperdal) • Olanzapine (Zyprexa) • Quetiapine (Seroquel) • Ziprasidone (Geodon) • Aripiprazole (Abilify) • *Paliperidone (Invega) • *Iloperidone (Fanapt) • *Asenapine (Saphris) • *Lurasidone (Latuda)

19. 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

20. 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

21. 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

22. Olanzapine (Zyprexa) • FDA approved for the treatment of: • Bipolar Disorder 13 to 17 years old • Schizophrenia 13 to 17 years old

23. *Paliperidone (Invega) • FDA approved for the treatment of: • Schizophrenia 12 to 17 years old

24. Clozapine (Clozaril) • Gold standard for treating schizophrenia • Two previous therapeutic trials • Clozaril National Registry • Labs each week X 6 months

25. Mood Stabilizers

26. Mood Stabilizers • Lithium • Anticonvulsants or AED

27. Lithium (Eskalith, Lithobid) • Effective in treating manic symptoms • Used in combination with other medications to treat resistant depression • Protects against suicidal behavior • “Lost” medication

28. Anticonvulsants/AED • Divalproex Sodium (Depakote) • Carbamazepine (Tegretol) • Oxcarbazepine (Trileptal) • Gabapentin (Neurontin) • Topiramate (Topamax)

29. AntidepressantMedications

30. The Opposite of Depression is….

31. Classes of Antidepressant • Tricyclic Antidepressants • Selective Serotonin Reuptake Inhibitors • Novel Antidepressant

32. Tricyclic Antidepressants • Amitriptyline (Elavil) • Imipramine (Tofranil) • Clomipramine (Anafranil)

33. Tricyclics • Depression Not recommended • OCD Clomipramine • ADHD Imipramine • School Phobia Mixed Results • Bedwetting Amitriptyline/Imipramine • Night Terrors Imipramine

34. Selective Serotonin Reuptake Inhibitors (SSRIs) • Preferred medications for treating child and adolescent depression • First line treatment for GAD, OCD, PTSD, and panic disorder

35. Selective Serotonin Reuptake Inhibitors • Fluoxetine (Prozac) • Parosetine (Paxil) • Sertraline (Zoloft) • Fluvoxamine (Luvox) • Citalopram (Celexa) • Escitalopram (Lexapro) • *Vilazodone (Vibryd)

36. 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

37. Sertraline (Zoloft) • FDA approved OCD 6 to 17 years old • Scored tablets provide flexibility

38. Fluvoxamine (Luvox) • FDA approved OCD 8 to 17 years old • Generic fluvoxamine is available

39. Escitalopram (Lexapro) • FDA approved MDD 12 to 17 years old • Don’t need much • 10 mg. is about the same as 40 mg. Celexa

40. SSRI Summary • SSRIs preferred in child/teen depression • Lexapro Depression • Prozac Depression and OCD • Zoloft OCD • Fluvoxamine OCD

41. Novel Antidepressants • Bupropion (Wellbutrin, *Aplenzin) • Mirtazapine (Remeron) • Venlafaxine (Effexor) • Desvenlafaxine (Pristiq) • Duloxetine (Cymbalta) • Trazodone (*Oleptro)

42. 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

43. 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

44. Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) • Venlafaxine (Effexor) • Desvenlafaxine (Pristiq) • Duloxetine (Cymbalta)

45. Venlafaxine (Effexor, Effexor XR) • Not recommended due to side effects (increased diastolic blood pressure, increased pulse, dermatological)

46. Duloxetine (Cymbalta) • Relief of physical symptoms • Do NOT use with a history of liver disease

47. 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”

48. Resources • ParentsMedGuide.org • American Academy of Child and Adolescent Psychiatry