The AAP recommends that pediatricians be adept in the prescribing and management of ADHD medications (stimulants and non-stimulants) and SSRIs for depression and anxiety.
You may have patients taking other psychotropic medications for various reasons, and it is helpful to know what these medications are, their indications, actions, adverse effects, and other concerns.
Other anti-anxiety medications
Buspirone: serotonin 1A receptor partial agonist, not effective in pediatric trials, requires bid-tid dosing, minimal side effect profile
Benzodiazapines: have a role in inpatient settings or sedation for procedures, but they have no role in outpatient primary care mental health treatment, and no evidence base for the treatment of generalized anxiety disorder, social anxiety disorder or separation anxiety disorder in children or adolescents. Non-medical use and diversion of benzodiazepines is common, may begin in early adolescence, and occurs often with benzodiazepines prescribed in emergency or primary care settings.
Antihistamines: may be used scheduled or prn, limited by sedation or by paradoxical disinhibition
- cyproheptadine - less sedating, less anxiolytic, may be used as appetite stimulant in children with illness- or stimulant-associated appetite suppression
- Used for depression, ADHD (third-line), smoking cessation
- Weight-neutral, non-sedating
- Contraindicated if seizure history or eating d/o as may lower seizure threshold
- Used for depression and anxiety
- May help with sleep onset
- Causes weight gain- may be beneficial for patients who need to gain weight
- Used for depression, and more often for sleep onset
- May cause orthostatic hypotension and rarely, priapism
Mood stabilizers are not a class of medications, but simply medications used to treat mania, to serve as maintenance treatment in bipolar disorder, and sometimes in an off-label manner to treat severe aggressive behavior. Mood stabilizers include antipsychotics, lithium, and various anti-epileptic drugs with which you are likely familiar. The notes below highlight some aspects of each medication that you should be aware of if you have a patient taking it.
- Highly effective for many patients with bipolar disorder
- Offers some protection against suicidality
- Must monitor: renal and thyroid function, weight, baseline ECG
- May worsen acne
- Teratogenicity may be less than thought (cardiac)
- Effective for many patients with bipolar disorder
- Must monitor weight, liver function
- Teratogenic; not recommended for teen females
Lamotrigine: indicated for bipolar depression. Slow titration is required to minimize risk of Stevens Johnson. Lamotrigine is otherwise well-tolerated and weight neutral.
Oxcarbazapine: little evidence of efficacy, well tolerated, minimal weight gain.