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Psychiatric Medication for Children

Psychiatric Medication for Children. Brief Presentation John O. Viesselman, M.D. December 1, 1999. What Are Psychiatric Medications used for in Children?. ADHD – inattentiveness, distractibility, disruptiveness, impulsivity, hyperactivity

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Psychiatric Medication for Children

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  1. Psychiatric Medication for Children Brief Presentation John O. Viesselman, M.D. December 1, 1999

  2. 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

  3. 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)

  4. 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

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

  6. SSRI Antidepressants • Prozac (fluoxetine) • Paxil (paroxetine) • Zoloft (sertraline) • Luvox (fluvoxamine) • Celexa (citalopram)

  7. SSRI Dosages

  8. SSRI Side Effects

  9. SSRI Side Effects

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

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

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

  13. 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

  14. 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

  15. 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

  16. Mood Stabilizers - Lithium • Side Effects in children • vomiting 32 % • headache 17 % • nausea 24 % • tremor 19 % • drowsiness 2 % • anorexia 9 % • diarrhea 5 % • frequent urination 5 %

  17. 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)

  18. 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)

  19. 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

  20. Major Tranquilizers(Atypical Antipsychotics)

  21. Major Tranquilizers(Classical Antipsychotics)

  22. Major TranquilizersTherapeutic Effects

  23. Major TranquilizersSide Effects

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