Psychiatric Medications - Medications for Children

Written by NIMH

Addendum to Medications Booklet January 2007

This addendum to the booklet Medications for Mental Illness (2005) was prepared to provide updated information on medications in the booklet and results of recent research on medications. This addendum also applies to the Medications Web page document.

UPDATES

Nefazodone/brand name Serzone: The manufacturer discontinued sales of the antidepressant in the U.S. effective June 14, 2004.

Despite the relative safety and popularity of SSRIs and other antidepressants, some studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. In 2004, after a thorough review of data, the Food and Drug Administration (FDA) adopted a "black box" warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the agency extended the warning to include young adults up to age 25. A "black box" warning is the most serious type of warning on prescription drug labeling. The warning emphasizes that children, adolescents and young adults taking antidepressants should be closely monitored, especially during the initial weeks of treatment, for any worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. See list of antidepressants medications at the end of this Addendum.

Below are further details concerning side effects of antipsychotic medications found on pages 5 and 6 in the original Medications for Mental Illness booklet. The medications discussed below are primarily used to treat schizophrenia or other psychotic disorders.

The typical (conventional) antipsychotic medications include chlorpromazine (Thorazine®), haloperidol (Haldol®), perphenazine (Etrafon, Trilafon®), and fluphenzine (Prolixin®). The typical medications can cause extrapyramidal side effects, such as rigidity, persistent muscle spasms, tremors, and restlessness.

In the 1990s, atypical (second generation) antipsychotics were developed that are less likely to produce these side effects. The first of these was clozapine (Clozaril®, Prolixin®), introduced in 1990. It treats psychotic symptoms effectively even in people who do not respond to other medications. However, it can produce a serious but rare problem called agranulocytosis, a loss of the white blood cells that fight infection. Therefore, patients who take clozapine must have their white blood cell counts monitored every week or two. The inconvenience and cost of both the blood tests and the medication itself has made treatment with clozapine difficult for many people, but it is the drug of choice for those whose symptoms do not respond to other typical and atypical antipsychotic medications.

After clozapine was introduced, other atypical antipsychotics were developed, such as risperidone (Risperdal®), olanzapine (Zyprexa®), quietiapine (Seroquel®) and ziprasidone (Geodon®). The newest atypicals include aripiprazole (Abilify®) and paliperidone (Invega®). All are effective and are less likely to produce extrapyramidal symptoms or agranulocytosis. However, they can cause weight gain, which may result in an increased risk of diabetes and high cholesterol level.^1,2

The FDA has determined that the treatment of behavioral disorders in elderly patients with atypical (second generation) antipsychotic medications is associated with increased mortality. These medications are not approved by the FDA for the treatment of behavioral disorders in patients with dementia.

In October 2006, the FDA approved risperidone (Risperdal®) for the symptomatic treatment of irritability in autistic children and adolescents ages 5 to 16. The approval is the first for the use of a drug to treat behaviors associated with autism in children. These behaviors are included under the general heading of irritability, and include aggression, deliberate self-injury and temper tantrums.

Fluoxetine (Prozac®) and sertraline (Zoloft®) are approved by the FDA for children age 7 and older with obsessive-compulsive disorder. Fluoxetine is also approved for children age 8 and older for the treatment of depression. Fluoxetine and sertraline are selective serotonin reuptake inhibitors (SSRIs). See above for the (FDA) warning concerning SSRIs and other antidepressants.