Many treatments are available to help these children. The treatments include both medications and psychotherapy--behavioral therapy, treatment of impaired social skills, parental and family therapy, and group therapy. The therapy used is based on the child's diagnosis and individual needs.

When the decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, and others who have charge of the child) is essential. Children should be watched and questioned for side effects because many children, especially younger ones, do not volunteer information. They should also be monitored to see that they are actually taking the medication and taking the proper dosage on the correct schedule.

Childhood-onset depression (comprehensive info on antidepressants for children here) and anxiety are increasingly recognized and treated. However, the best-known and most-treated childhood-onset mental disorder is attention deficit hyperactivity disorder (ADHD). Children with ADHD exhibit symptoms such as short attention span, excessive motor activity, and impulsivity which interfere with their ability to function especially at school. The medications most commonly prescribed for ADHD are called stimulants. These include methylphenidate (Ritalin, Metadate, Concerta), amphetamine (Adderall), dextroamphetamine (Dexedrine, Dextrostat), and pemoline (Cylert). Because of its potential for serious side effects on the liver, pemoline is not ordinarily used as a first-line therapy for ADHD. Some antidepressants such as bupropion (Wellbutrin) are often used as alternative medications for ADHD for children who do not respond to or tolerate stimulants.

Based on clinical experience and medication knowledge, a physician may prescribe to young children a medication that has been approved by the FDA for use in adults or older children. This use of the medication is called "off-label." Most medications prescribed for childhood mental disorders, including many of the newer medications that are proving helpful, are prescribed off-label because only a few of them have been systematically studied for safety and efficacy in children. Medications that have not undergone such testing are dispensed with the statement that "safety and efficacy have not been established in pediatric patients." The FDA has been urging that products be appropriately studied in children and has offered incentives to drug manufacturers to carry out such testing. The National Institutes of Health and the FDA are examining the issue of medication research in children and are developing new research approaches.

The use of the other medications described in this site is more limited with children than with adults. Therefore, a special list of medications for children, with the ages approved for their use, appears immediately after the general list of medications. Also listed are NIMH publications with more information on the treatment of both children and adults with mental disorders.

How psychiatric medications work
Psychiatric medications and children

The Elderly

Persons over the age of 65 make up almost 13 percent of the population of the United States, but they receive 30 percent of prescriptions filled. The elderly generally have more medical problems, and many of them are taking medications for more than one of these conditions. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication.

The elderly are also more likely to take too much of a medication accidentally because they forget that they have taken a dose and take another one. The use of a 7-day pill-box, as described earlier, can be especially helpful for an elderly person.

The elderly and those close to them--friends, relatives, caretakers--need to pay special attention and watch for adverse (negative) physical and psychological responses to medication. Because they often take more medications--not only those prescribed but also over-the-counter preparations and home, folk, or herbal remedies--the possibility of adverse drug interactions is high.

(more about depression in elderly)

Women During The Childbearing Years

Because there is a risk of birth defects with some psychotropic medications during early pregnancy (antidepressants and pregnancy), a woman who is taking such medication and wishes to become pregnant should discuss her plans with her doctor. In general, it is desirable to minimize or avoid the use of medication during early pregnancy. If a woman on medication discovers that she is pregnant, she should contact her doctor immediately. She and the doctor can decide how best to handle her therapy during and following the pregnancy. Some precautions that should be taken are:

• If possible, lithium should be discontinued during the first trimester (first 3 months of pregnancy) because of an increased risk of birth defects.
• If the patient has been taking an anticonvulsant such as carbamazepine (Tegretol) or valproic acid (Depakote)--both of which have a somewhat higher risk than lithium--an alternate treatment should be used if at all possible. The risks of two other anticonvulsants, lamotrigine (Lamictal) and gabapentin (Neurontin) are unknown. An alternative medication for any of the anticonvulsants might be a conventional antipsychotic or an antidepressant, usually an SSRI. If essential to the patient's health, an anticonvulsant should be given at the lowest dose possible. It is especially important when taking an anticonvulsant to take a recommended dosage of folic acid during the first trimester.
• Benzodiazepines are not recommended during the first trimester.