Psychiatric Medication for Children

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Psychiatric Medication for Children

• Brief Presentation
• John O. Viesselman, M.D.
• December 1, 1999

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What Are Psychiatric Medications used for in
Children?

• ADHD inattentiveness, distractibility,
  disruptiveness, impulsivity, hyperactivity
• Anxiety Depression depression, insomnia,
  nightmares, flashbacks, worry, impaired
  concentration, declining school grades, fatigue,
  hopelessness, suicidality
• Aggressiveness Psychosis violence and violent
  impulses, agitation, assault, property
  destruction, hallucinations, delusions, thought
  disorder

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ADHD Medications

• Stimulants Treatment of choice
• methylphenidate (Ritalin, Concerta)
• dextroamphetamine (Dexedrine, Adderall)
• rarely methamphetamine (Desoxyn) because of abuse
  potential
• Antidepressants - Second Line treatment
• bupropion (Wellbutrin)
• tricyclics (imipramine, nortriptyline,
  desipramine)

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ADHD Medication Dosage

• Dexedrine 5, 10, 15 mg tabs 5, 10, 15 mg
  spansules 5 mg/5 cc elixir generic 5, 10 mg
  tabs only
• Ritalin 5, 10, 20 mg tabs, 20 mg SR generic 5,
  10 20 tabs only
• Concerta 18, 27, 36, 54 SR

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Affective DisordersMedications

• Depression - antidepressants
• SSRIs
• Tricyclic antidepressants
• Other antidepressants
• Bipolar Disorder - mood stabilizers
• Lithium
• Tegretol
• Depakote, Klonopin

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SSRI Antidepressants

• Prozac (fluoxetine)
• Paxil (paroxetine)
• Zoloft (sertraline)
• Luvox (fluvoxamine)
• Celexa (citalopram)

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SSRI Dosages
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SSRI Side Effects
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SSRI Side Effects
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Tricyclic Antidepressants

• Elavil (amitriptyline)
• Tofranil (imipramine)
• Sinequan (doxepin)
• Anafranil (clomipramine)
• Norpramin (desipramine)
• Pamelor (nortriptyline)
• Vivactil (protriptyline)
• Surmontil (trimipramine)

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Tricyclic Antidepressants Side Effects

• Anticholinergic Side Effects - dry mouth,
  drowsiness, constipation, urinary retention,
  blurry vision, dizziness, tremors
• stomach ache
• palpitations
• sweating
• sleep problems

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Other Antidepressants

• Wellbutrin (bupropion)
• Effexor (venlafaxine)
• Desyrel (trazodone)
• Serzone (nefazodone)
• Asendin (amoxapine)
• Ludiomil (maprotiline)
• Remeron (mirtazepine)

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Other Antidepressants Wellbutrin

• Side effects - Dizziness, constipation, nausea,
  dry mouth, sweating, insomnia, tremor, agitation,
  blurry vision
• Helps in depression, smoking, anxiety ADHD
• 2 studies - as or almost effective as Ritalin
• Dosages 75, 100 mg tablets, 100, 150 SR tablets
• Usual dosage 100, 200, or 300 mg /day in divided
  doses

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Other Antidepressants Trazodone

• Side effects - Drowsiness, dizziness,
  light-headedness, tiredness, nausea, ataxia,
  confusion, dry mouth
• Helps depression, anxiety, aggressiveness, sleep
• Dosages 50, 100, 150 mg tablets
• Usual dosage 50, 100, 150, 200 mg at bedtime
• Often used with SSRIs to augment antidepressant
  effect help sleep

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Mood Stabilizers

• Lithium, Tegretol (carbamazepine), Depakote
  (valproic acid)
• Depakote associated with polycycstic ovaries and
  menstrual disturbances in 80 of women under the
  age of 20 treated for epilepsy - should not be
  used in young females and probably avoided in
  males as well

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Mood Stabilizers - Lithium

• Side Effects in children
• vomiting 32
• headache 17
• nausea 24
• tremor 19
• drowsiness 2
• anorexia 9
• diarrhea 5
• frequent urination 5

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Mood Stabilizers - Lithium

• Other Side Effects
• acne
• weight gain
• transient hypothyroidism
• toxicity
• Blood levels needed to prevent toxicity (nausea,
  vomiting, diarrhea, tremor, disturbed gait,
  confusion, slurred speech, kidney dysfunction,
  electrolyed imbalance, apathy, convulsions, coma)

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Mood Stabilizers - Tegretol

• Tegretol (carbamazepine) is related to tricyclic
  antidepressants
• Side Effects
• similar to tricyclic antidepressants
• in addition - vertigo, unsteadiness, nausea,
  vomiting, dizziness, rash
• Transient lowering of white cell count
• Cases of hepatitis and eosinophilic myocarditis
  (resulting in death)

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Mood Stabilizers - Tegretol

• Therapeutic Effects
• No proven therapeutic indications in children and
  adolescents
• May be tried in mania that has not responded to
  Lithium
• Might also be tried for emotional instability and
  aggressiveness that have not responded to Lithium

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Major Tranquilizers(Atypical Antipsychotics)
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Major Tranquilizers(Classical Antipsychotics)
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Major TranquilizersTherapeutic Effects
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Major TranquilizersSide Effects