Medications for Special Groups

Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing.

In general, the information throughout this booklet applies to these groups, but the following are a few special points to keep in mind.

Children

The 1999 MECA Study (Methodology for Epidemiology of Mental Disorders in Children and Adolescents) estimated that almost 21 percent of U.S. children ages 9 to 17 had a diagnosable mental or addictive disorder that caused at least some impairment. When diagnostic criteria were limited to significant functional impairment, the estimate dropped to 11 percent, for a total of 4 million children who suffer from a psychiatric disorder that limits their ability to function.⁶

It is easy to overlook the seriousness of childhood mental disorders. In children, these disorders may present symptoms that are different from or less clear-cut than the same disorders in adults. Younger children, especially, and sometimes older children as well, may not talk about what is bothering them. For this reason, it is important to have a doctor, another mental health professional, or a psychiatric team examine the child.

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 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 booklet 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.

continue: Psychiatric Medications for the Elderly and Women Before and During Pregnancy