Depression in children is caused by a combination of three things: genetics, what is happening in a person's life, and what is going on in their body. Usually, more than one is present in a child.

For a child to get depressed, there must either be major things wrong with their lives, something major wrong with their body and or mind, or a strong family history of depression. Often more than one is present.

Medical problems - children who have chronic medical problems are much more likely to get depression. Severe asthma, severe head injury, diabetes, epilepsy, and many of the less common chronic childhood diseases can result in depression.

Neuropsychiatric - Children with certain disorders of the brain often get depression because the same chemicals and the same nerve pathways are involved in both. Children with the following neuropsychiatric illness are more likely to get depression: attention deficit hyperactivity disorder, learning disabilities, tourettes, anxiety disorders, eating disorders, obsessive compulsive disorder, and autism and related conditions.

Environment - Some children, but not all, react to problems in their environment with depression signs and symptoms. Common causes are abuse of all kinds, families that are in chaos, neglect, poverty, no consistent parent, school, or home, and horrible things like witnessing deaths, finding bodies, losing parents, etc. Although children who get depressed are more likely to have a stressful life event happen to them in the year before they get ill, the more important relationship is for children who have multiple stressful events. In a recent study, 50% of depressed children and adolescents had two or more major stressors in the year before getting depressed. In children without depression, no child had two or more major stressors in the past year. There is an interaction between environment and genes. If bad things happen to a child and there is a family history of depression, a depressed child is a very likely outcome.

Television - Children who are watching a lot of TV are more likely to have a host of different psychiatric symptoms. Recent studies have shown kids who are watching over 6 hours a day have more problems with depression, anxiety, and aggression.

Drugs and Alcohol - Substance abuse is very common, especially alcohol and marijuana. About 14% of teenagers test positive for street drugs on a urine drug screen when they come to their family doctor. Almost all of this is marijuana. Just as with adults, a child can develop all the signs of depression due to drugs and alcohol use. However, recent research has found that it is more common that a child will become depressed and then start using drugs or alcohol rather than the other way around. In adults, when people stop drinking or using drugs, their depression usually clears over the next two to four weeks. In children and adolescents, this rarely happens. Even after they are clean, most depressed teens and children are still depressed.

Genetics - If one of the parents has depression, about 40% of the children will get depressed at sometime before their 20th birthday. The younger the parent was when he or she got depressed, the more likely the children are to become depressed. When mothers have been seriously depressed (an episode every year or so and hospitalized at least once for depression) their children are even more likely to become depressed, and when they do it is more severe, last longer, and is accompanied by other psychiatric problems, too. These children also are more likely to commit suicide.

Why Does Depression Run in Families?

1. Genetics - Even if a child never has contact with a parent, if that parent was depressed, it means that the children are also more likely to get depressed, too.

2. Marital Difficulities - Depression in adults goes hand-in-hand with marital problems. The combination of divorce plus depression in parents makes it much more likely that the children will get depressed.

3. Parenting Problems - It is darn hard to be a good parent when you are depressed, and it can be pretty depressing trying to parent a depressed child. Parenting problems, whether they come from the parent or the child, can make everyone's depression worse.

next: When Parents Are Depressed
~ depression library articles
~ all articles on depression

Warning/Disclaimer

These medication patient information pages describe why a particular psychiatric medication is prescribed, important facts about the medication and how you should take it, along with side effects, food and drug interactions, special warnings, taking the medication during pregnancy, recommended dosage and overdose information. Almost all the psychiatric medications such as antidepressants, antipsychotics, and antianxiety medications are covered and presented in plain English.

Go here if you are looking for the Psychiatric Medications Pharmacology section which contains more detailed information on each medication. They are also linked from each patient information page.

The information in the "Psychiatric Medications Patient Information" section of HealthyPlace.com has been selectively abstracted from various sources. The intended use is as an educational aid and does not cover all possible uses, actions, precautions, side effects, or interactions of any of these medications. This information is not intended as medical advice for individual problems or for making an evaluation as to the risks and benefits of taking a particular drug.

The information here should not be used as a substitute for a consultation or visit with your family physician or other health care provider.

We strongly suggest and encourage you to consult with a licensed physician for answers to any questions you may have about these or other medications.

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Find out why Topamax is prescribed, side effects of Topamax, Topamax warnings, effects of Topamax during pregnancy, more - in plain English.

Generic name: Topiramate
Brand name: Topamax

Pronounced: TOW-pah-macks

Category: Anticonvulsant Medication

Full Topamax Prescribing Information

Why is Topamax prescribed?

Topamax is an antiepileptic drug, prescribed to control both the mild attacks known as partial seizures and the severe tonic-clonic convulsions known as grand mal seizures. It is typically added to the treatment regimen when other drugs fail to fully control a patient's attacks.

Most important fact about this drug

Do not abruptly stop taking Topamax. If the drug isn't withdrawn gradually, the frequency of your seizures could increase.

How should you take this medication?

It is important to take this medication exactly as prescribed. It can be taken with or without food. Avoid breaking the tablets; the medication has a bitter taste.

Topamax capsules may be swallowed whole, or the capsule may be opened and its contents sprinkled on a teaspoonful of soft food. To open the capsule, hold it so you can read the word ``top'' and carefully twist off the clear portion of the capsule. The drug and food mixture should be swallowed whole and not chewed. Do not store the mixture for future use.

Topamax increases your risk of developing kidney stones. To prevent this problem, be sure to take this medication with plenty of fluids.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take two doses at once.

--Storage instructions...

Store Topamax at room temperature in a tightly closed container. Protect the tablets from moisture.

What side effects may occur?

Some side effects, such as fatigue, are more likely to surface with high doses of Topamax. Others occur regardless of dosage. While many tend to disappear after the first 8 weeks of therapy, it's still important to report them to your doctor. Only your doctor can determine if it is safe for you to continue taking Topamax.

• More common side effects may include: Abdominal pain, abnormal coordination, abnormal vision, agitation, anxiety, appetite loss, back pain, breast pain, chest pain, confusion, constipation, depression, difficulty with concentration, difficulty with memory, dizziness, double vision, drowsiness, fatigue, flu-like symptoms, indigestion, language problems, leg pain, loss of coordination, menstrual problems, mood problems, nausea, nervousness, nose inflammation, rash, sinusitis, slowing of movements, sore throat, speech problems, tingling or burning sensations, tremors, weakness, weight loss
• Less common side effects may include: Abnormal gait, abnormal menstrual bleeding, acne, aggressiveness, allergy, apathy, bladder infection, changes in taste, bloody urine, body odor, decreased awareness, decreased mobility, decreased sensitivity, diarrhea, digestive inflammation, dry mouth, exaggerated sense of well being, eye pain, feelings of illness, feelings of unreality, fever, fluid retention, frequent urination, gas, gum inflammation, hair loss, hallucinations, headache, hearing difficulties, hot flushes, hyperactivity, impotence, increased sweating, involuntary muscle movement, irritable bladder, joint pain, kidney stones, loss of balance, loss of consciousness, low sex drive, mood swings, muscle ache, muscle tension, muscle weakness, nosebleeds, painful or difficult urination, personality problems, pinkeye, ringing in the ears, sensitivity to touch, severe itching, shivers, shortness of breath, sleeplessness, suicidal tendencies, swelling, upper respiratory infection, urinary infection, urinary incontinence, vaginal infection, vomiting, weight gain In children, the more common side effects are abnormal gait, aggressiveness, behavior problems, confusion, constipation, difficulty concentrating, difficulty with memory, difficulty sleeping, dizziness, drowsiness, fatigue, increased muscle movement, increased saliva, injury, loss of appetite, loss of coordination, nausea, nervousness, nosebleed, pneumonia, rash, speech problems, urinary incontinence, viral infection, and weight loss.
• Other, less common side effects in children include: allergic reaction, digestive inflammation, increased thirst, skin disorders, slowing of movement, vaginal discharge, vision disorders, and weakened reflexes.

Topamax has also been known to cause a number of very rare side effects in adults and children (typically striking less than one person in a hundred). If you develop any unfamiliar problems while taking Topamax, report them to your doctor.

Why should this drug not be prescribed?

If Topamax gives you an allergic reaction, you'll be unable to use the drug.

Special warnings about this medication

Because Topamax sometimes causes confusion, dizziness, fatigue, and problems with coordination and concentration, you should not drive, operate machinery, or participate in any hazardous activity that requires full mental alertness until you are certain how the drug affects you.

Topamax has been known to trigger severe nearsightedness along with increased pressure inside the eye. The problem usually occurs within 1 month of starting treatment. If you develop blurred vision or eye pain, call your doctor immediately. Discontinuation of the drug may be necessary to prevent permanent vision loss.

Tell your doctor if you have kidney problems or if you are on hemodialysis. Your dosage of Topamax may need adjustment. Also make sure the doctor is aware of any liver disorder you may have. Topamax must be used cautiously by individuals with impaired liver function.

Possible food and drug interactions when taking this medication

If Topamax is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Topamax with:

• Acetazolamide (Diamox)
• Carbamazepine (Tegretol)
• Dichlorphenamide (Daranide)
• Digoxin (Lanoxin)
• Metformin (Glucophage)
• Phenytoin (Dilantin)
• Oral contraceptives
• Valproic acid (Depakene)

Topamax can depress the central nervous system. Be extremely cautious about combining it with alcohol, sedatives, tranquilizers, and other central nervous system depressants.

Special information if you are pregnant or breastfeeding

In animal studies, Topamax has caused harm to the developing fetus, and its safety has not been verified in pregnant humans. It is recommended for use during pregnancy only if the doctor feels that its potential benefit outweighs the potential risk to the infant.

This medication may appear in breast milk, and its possible effect on the nursing infant remains unknown. Check with your doctor if you plan to breastfeed your baby.

Recommended dosage

ADULTS

Topamax therapy usually begins with a dose of 50 milligrams once daily during the first week. The daily dosage is then increased each week until, by the eighth week, the patient is taking 200 milligrams twice a day. For people with poor kidney function, the dosage is usually cut in half. On the other hand, those undergoing hemodialysis may need a supplemental dose.

If you are also taking Dilantin or Tegretol, the dosage of Topamax may need adjustment. Likewise, the doctor may adjust your dosage if you have liver problems.

CHILDREN

The usual daily dose for children 2 to 16 years of age is 5 to 9 milligrams for every 2.2 pounds of body weight, divided into two doses. Topamax therapy usually begins with a dose of 25 milligrams (or less) once daily during the first week. The daily dosage is then increased each week until the doctor is satisfied with the patient's response. It may take eight weeks to reach the ideal dose.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

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Find out why Navane (Thiothixene) is prescribed, side effects of Navane, Navane warnings, effects of Navane during pregnancy, more - in plain English.

Generic name: Thiothixene
Brand name: Narvane

Pronounced: NA-vain

Full Navane Prescribing Information

Why is Navane prescribed?

Navane is used in the treatment of schizophrenia (a disruption of thought and the understanding of reality). Researchers theorize that antipsychotic medications such as Navane work by lowering levels of dopamine, a neurotransmitter (or chemical messenger) in the brain. Excessive levels of dopamine are believed to be related to psychotic behavior.

Most important fact about Navane

Navane may cause tardive dyskinesia--a condition marked by involuntary muscle spasms and twitches in the face and body. This condition can be permanent and appears to be most common among the elderly, especially women. Ask your doctor for information about this possible risk.

How should you take Navane?

Navane may be taken in liquid or capsule form. In liquid form, a dropper is supplied.

--If you miss a dose...

Take it as soon as you remember. If it is within 2 hours of your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature away from heat, light, and moisture. Keep the liquid form from freezing.

What side effects may occur with Navane?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Navane.

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• Side effects of Navane may include: Abnormal muscle rigidity, abnormal secretion of milk, abnormalities in movements and posture, agitation, anemia, blurred vision, breast development in males, chewing movements, constipation, diarrhea, dizziness, drowsiness, dry mouth, excessive thirst, eyeball rotation or state of fixed gaze, fainting, fatigue, fluid accumulation and swelling, headache, high fever, high or low blood sugar, hives, impotence, insomnia, intestinal blockage, involuntary movements of the arms and legs, irregular menstrual periods, itching, light-headedness, loss or increase of appetite, low blood pressure, narrow or dilated pupils of the eye, nasal congestion, nausea, painful muscle spasm, protruding tongue, puckering of mouth, puffing of cheeks, rapid heartbeat, rash, restlessness, salivation, sedation, seizures, sensitivity to light, severe allergic reaction, skin inflammation and peeling, strong reflexes, sweating, swelling of breasts, tremors, twitching in the body, neck, shoulders, and face, visual problems, vomiting, weakness, weight increase, worsening of psychotic symptoms

Why should Navane not be prescribed?

Do not give Navane to comatose individuals. Do not take Navane if you are known to be hypersensitive to it. Also, you should not be using Navane if the activity of your central nervous system is slowed down for any reason--for example, by a sleeping medication, if you have had circulatory system collapse, or if you have an abnormal bone marrow or blood condition.

Special warnings about Navane

Navane may hide symptoms of brain tumor and intestinal obstruction. Your doctor will prescribe Navane cautiously if you have or have ever had a brain tumor, breast cancer, convulsive disorders, the eye condition called glaucoma, intestinal blockage, or heart disease; or if you are exposed to extreme heat or are recovering from alcohol addiction.

This drug may impair your ability to drive a car or operate potentially dangerous machinery. Do not participate in any activities that require full alertness if you are unsure of your ability.

Possible food and drug interactions when taking Navane

If Navane is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Navane with the following:

Antihistamines such as Benadryl Barbiturates such as phenobarbital Drugs that contain atropine, such as Donnatal

Extreme drowsiness and other potentially serious effects can result if Navane is combined with alcohol or other central nervous system depressants such as painkillers, narcotics, or sleeping medications.

Special information if you are pregnant or breastfeeding

If you are pregnant or plan to become pregnant, inform your doctor immediately; pregnant women should use Navane only if clearly needed. Consult your doctor if you are breastfeeding; he or she may have you stop while you are taking Navane.

Recommended dosage for Navane

Dosages of Navane are tailored to the individual. Usually treatment begins with a small dose, which is increased if needed.

ADULTS

For Milder Conditions

The usual starting dosage is a daily total of 6 milligrams, divided into doses of 2 milligrams and taken 3 times a day. Your doctor may increase the dose to a total of 15 milligrams a day.

For More Severe Conditions

The usual starting dosage is a daily total of 10 milligrams, taken in 2 doses of 5 milligrams each. Your doctor may increase this dose to a total of 60 milligrams a day.

Taking more than 60 milligrams a day rarely increases the benefits of Navane.

Some people are able to take Navane once a day. Check with your doctor to see whether you can follow this schedule.

CHILDREN

Navane is not recommended for children younger than 12 years old.

OLDER ADULTS

In general, older adults are prescribed dosages of Navane in the lower ranges. Because older adults may develop low blood pressure while taking Navane, their doctors will monitor them closely. Older adults (especially women) may be more susceptible to such side effects as involuntary muscle spasms and twitches in the face and body. Check with your doctor for more information about these potential risks.

Overdosage of Navane

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical help immediately.

Symptoms of Navane overdose may include: Central nervous system depression, coma, difficulty swallowing, dizziness, drowsiness, head tilted to the side, low blood pressure, muscle twitching, rigid muscles, salivation, tremors, walking disturbances, weakness

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Find out why Nardil (Phenelzine) is prescribed, side effects of Nardil, Nardil warnings, effects of Nardil during pregnancy, more - in plain English.

Generic name: Phenelzine sulfate
Brand name: Nardil

Pronounced: NAHR-dill

Full Nardil (Phenelzine) Prescribing Information

Why is Nardil prescribed?

Nardil is a monoamine oxidase (MAO) inhibitor used to treat depression as well as anxiety or phobias mixed with depression. MAO is an enzyme responsible for breaking down certain neurotransmitters (chemical messengers) in the brain. By inhibiting MAO, Nardil helps restore more normal mood states. Unfortunately, MAO inhibitors such as Nardil also block MAO activity throughout the body, an action that can have serious, even fatal, side effects--especially if MAO inhibitors are combined with other foods or drugs containing a substance called tyramine.

Most important fact about Nardil

Avoid the following foods, beverages, and medications while taking Nardil and for 2 weeks thereafter:

Beer (including alcohol-free or reduced-alcohol beer)
Caffeine (in excessive amounts)
Cheese (except for cottage cheese and cream cheese)
Chocolate (in excessive amounts)
Dry sausage (including Genoa salami, hard salami, pepperoni, and Lebanon bologna)
Fava bean pods
Liver
Meat extract
Pickled herring
Pickled, fermented, aged, or smoked meat, fish, or dairy products
Sauerkraut Spoiled or improperly stored meat, fish, or dairy products
Wine (including alcohol-free or reduced-alcohol wine)
Yeast extract (including large amounts of brewer's yeast)
Yogurt

• Medications to avoid:
  Amphetamines, Appetite suppressants such as Redux and Tenuate, Antidepressants and related medications such as Prozac, Effexor, Luvox, Paxil, Remeron, Serzone, Wellbutrin, Zoloft, Elavil, Triavil, Tegretol, and Flexeril, Asthma inhalants such as Proventil and Ventolin, Cold and cough preparations including those with dextromethorphan, such as Robitussin DM, Hay fever medications such as Contac and Dristan, L-tryptophan-containing products, Nasal decongestants in tablet, drop, or spray form such as Sudafed, Sinus medications such as Sinutab

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Taking Nardil with any of the above foods, beverages, or medications can cause serious, potentially fatal, high blood pressure. Therefore, when taking Nardil you should immediately report the occurrence of a headache, heart palpitations, or any other unusual symptom. In addition, make certain that you inform any other physician or dentist you see that you are currently taking Nardil or have taken Nardil within the last 2 weeks.

How should you take Nardil?

Nardil may be taken with or without food. Take it exactly as prescribed. It can take up to 4 weeks for the drug to begin working.

Use of Nardil may complicate other medical treatment. Always carry a card that says you take Nardil, or wear a Medic Alert bracelet.

--If you miss a dose...

Take it as soon as you remember. If it is within 2 hours of your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature.

What side effects may occur when taking Nardil?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Nardil.

• More common side effects of Nardil may include: Constipation, disorders of the stomach and intestines, dizziness, drowsiness, dry mouth, excessive sleeping, fatigue, headache, insomnia, itching, low blood pressure (especially when rising quickly from lying down or sitting up), muscle spasms, sexual difficulties, strong reflexes, swelling due to fluid retention, tremors, twitching, weakness, weight gain

• Less common or rare side effects may include: Anxiety, blurred vision, coma, convulsions, delirium, exaggerated feeling of well-being, fever, glaucoma, inability to urinate, involuntary eyeball movements, jitteriness, lack of coordination, liver damage, mania, muscular rigidity, onset of the mental disorder schizophrenia, rapid breathing, rapid heart rate, repetitious use of words and phrases, skin rash or lupus-like disease, sweating, swelling in the throat, tingling sensation, yellowed skin and whites of eyes

Why should Nardil not be prescribed?

You should not take this drug if you have pheochromocytoma (a tumor of the adrenal gland), congestive heart failure, or a history of liver disease, or if you have had an allergic reaction to it.

You should not take Nardil if you are taking medications that may increase blood pressure (such as amphetamines, cocaine, allergy and cold medications, or Ritalin), other MAO inhibitors, L-dopa, methyldopa (Aldomet), phenylalanine, L-tryptophan, L-tyrosine, fluoxetine (Prozac), buspirone (BuSpar), bupropion (Wellbutrin), guanethidine (Ismelin), meperidine (Demerol), dextromethorphan, or substances that slow the central nervous system such as alcohol and narcotics; or if you must consume the foods, beverages, or medications listed above in the "Most important fact about this drug" section.

Special warnings about Nardil

You must follow the food and drug limitations established by your physician; failure to do so may lead to potentially fatal side effects. While taking Nardil, you should promptly report the occurrence of a headache or any other unusual symptoms.

If you are diabetic, your doctor will prescribe Nardil with caution, since it is not clear how MAO inhibitors affect blood sugar levels.

If you are taking Nardil, talk to your doctor before you decide to have elective surgery.

If you stop taking Nardil abruptly, you may have withdrawal symptoms. They may include nightmares, agitation, strange behavior, and convulsions.

Possible food and drug interactions when taking Nardil

If Nardil is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is important that you closely follow your doctor's dietary and medication limitations when taking Nardil. Consult the "Most important fact about this drug" and "Why should this drug not be prescribed?" sections for lists of the foods, beverages, and medications that should be avoided while taking Nardil.

In addition, you should use blood pressure medications (including water pills and beta blockers) with caution when taking Nardil, since excessively low blood pressure may result. Symptoms of low blood pressure include dizziness when rising from a lying or sitting position, fainting, and tingling in the hands or feet.

Special information if you are pregnant or breastfeeding

The effects of Nardil during pregnancy have not been adequately studied. Nardil should be used during pregnancy only if the benefits of therapy clearly outweigh the potential risks to the fetus. If you are pregnant or plan to become pregnant, inform your doctor immediately. Nursing mothers should use Nardil only after consulting their physician, since it is not known whether Nardil appears in human milk.

Recommended dosage for Nardil

ADULTS

The usual starting dose is 15 milligrams (1 tablet) 3 times a day. Your doctor may increase the dosage to 90 milligrams per day. It may be 4 weeks before the drug starts to work.

Once you have had good results, your doctor may gradually reduce the dose, possibly to as low as 15 milligrams daily or every 2 days.

OLDER ADULTS

Because older people are more likely to have poor liver, kidney, or heart function, or other diseases that could increase the likelihood of side effects, a relatively low dose of Nardil is usually recommended at the start.

CHILDREN

Nardil is not recommended, since safety and efficacy for children under the age of 16 have not been determined.

Overdosage of Nardil

Any medication taken in excess can have serious consequences. An overdose of Nardil can be fatal. If you suspect an overdose, seek medical help immediately.

• Symptoms of a Nardil overdose may include: Agitation, backward arching of the head, neck, and back, cool, clammy skin, coma, convulsions, difficult breathing, dizziness, drowsiness, faintness, hallucinations, high blood pressure, high fever, hyperactivity, irritability, jaw muscle spasms, low blood pressure, pain in the heart area, rapid and irregular pulse, rigidity, severe headache, sweating

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Find out why Ritalin is prescribed, side effects of Ritalin, Ritalin warnings, effects of Ritalin during pregnancy, more - in plain English.

Generic name: Methylphenidate hydrochloride
Brand names: Ritalin, Concerta, Metadate, Methylin

Pronounced: RIT-ah-lin

Full Ritalin Prescribing Information

Why is Ritalin prescribed?

Ritalin and other brands of methylphenidate are mild central nervous system stimulants used in the treatment of attention deficit hyperactivity disorder in children. With the exception of Ritalin LA, Concerta and Metadate CD, these products are also used in adults to treat narcolepsy (an uncontrollable desire to sleep).

When given for attention deficit disorder, this drug should be an integral part of a total treatment program that includes psychological, educational, and social measures. Symptoms of attention deficit disorder include continual problems with moderate to severe distractibility, short attention span, hyperactivity, emotional changeability, and impulsiveness.

Most important fact about Ritalin

Excessive doses of this drug over a long period of time can produce addiction. It is also possible to develop tolerance to the drug, so that larger doses are needed to produce the original effect. Because of these dangers, be sure to check with your doctor before making any change in dosage; and withdraw the drug only under your doctor's supervision.

How should you take Ritalin?

Follow your doctor's directions carefully. It is recommended that methylphenidate be taken 30 to 45 minutes before meals. If the drug interferes with sleep, give the child the last dose before 6 p.m. Ritalin-SR, Ritalin LA, Metadate CD, Methylin ER, and Concerta are long-acting forms of the drug, taken less frequently. They should be swallowed whole, never crushed or chewed. (Ritalin LA and Metadate CD may also be given by sprinkling the contents of the capsule on a tablespoon of cool applesauce and administering immediately, followed by a drink of water.)

--If you miss a dose...

Give it to the child as soon as you remember. Give the remaining doses for the day at regularly spaced intervals. Do not give 2 doses at once.

--Storage instructions...

Keep out of reach of children. Store below 86 degrees Fahrenheit in a tightly closed, light-resistant container. Protect Ritalin-SR from moisture.

What side effects may occur when taking Ritalin?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue giving this drug.

• More common side effects of Ritalin may include: Inability to fall or stay asleep, nervousness

These side effects can usually be controlled by reducing the dosage and omitting the drug in the afternoon or evening.

In children, loss of appetite, abdominal pain, weight loss during long-term therapy, inability to fall or stay asleep, and abnormally fast heartbeat are more common side effects.

• Less common or rare side effects may include: Abdominal pain, abnormal heartbeat, abnormal muscular movements, blood pressure changes, chest pain, dizziness, drowsiness, fever, hair loss, headache, hives, jerking, joint pain, loss of appetite, nausea, palpitations (fluttery or throbbing heartbeat), pulse changes, rapid heartbeat, reddish or purplish skin spots, skin reddening, skin inflammation with peeling, skin rash, Tourette's syndrome (severe twitching), weight loss during long-term treatment

Why should Ritalin not be prescribed?

This drug should not be prescribed for anyone experiencing anxiety, tension, and agitation, since the drug may aggravate these symptoms.

Anyone sensitive or allergic to this drug should not take it.

This medication should not be taken by anyone with the eye condition known as glaucoma, anyone who suffers from tics (repeated, involuntary twitches), or someone with a family history of Tourette's syndrome (severe and multiple tics).

This drug is not intended for use in children whose symptoms may be caused by stress or a psychiatric disorder.

This medication should not be used for the prevention or treatment of normal fatigue, nor should it be used for the treatment of severe depression.

This drug should not be taken during treatment with drugs classified as monoamine oxidase inhibitors, such as the antidepressants Nardil and Parnate, nor for the 2 weeks following discontinuation of these drugs.

Special warnings about Ritalin

Your doctor will do a complete history and evaluation before prescribing this drug. He or she will take into account the severity of the symptoms, as well as your child's age.

This drug should not be given to children under 6 years of age; safety and effectiveness in this age group have not been established.

There is no information regarding the safety and effectiveness of long-term treatment in children. However, suppression of growth has been seen with the long-term use of stimulants, so your doctor will watch your child carefully while he or she is taking this drug.

Blood pressure should be monitored in anyone taking this drug, especially those with high blood pressure.

Some people have had visual disturbances such as blurred vision while being treated with this drug.

The use of this drug by anyone with a seizure disorder is not recommended. Be sure your doctor is aware of any problem in this area. Caution is also advisable for anyone with a history of emotional instability or substance abuse, due to the danger of addiction.

Possible food and drug interactions when taking Ritalin

If this medication is taken with certain other drugs, the effects of either can be increased, decreased, or altered. It is especially important to check with your doctor before combining this drug with the following:

Antiseizure drugs such as phenobarbital, Dilantin and Mysoline
Antidepressant drugs such as Tofranil, Anafranil, Norpramin, and Effexor
Blood thinners such as Coumadin
Clonidine (Catapres-TTS)
Drugs that restore blood pressure, such as EpiPen
Guanethidine (Ismelin)
MAO inhibitors (drugs such as the antidepressants Nardil and Parnate)
Phenylbutazone

Special information if you are pregnant or breastfeeding

The effects of Ritalin during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. It is not known if this drug appears in breast milk. If this medication is essential to your health, your doctor may advise you to discontinue nursing your baby until your treatment with this medication is finished.

Recommended dosage for Ritalin

ADULTS

Ritalin and Methylin Tablets

The average dosage is 20 to 30 milligrams a day, divided into 2 or 3 doses, preferably taken 30 to 45 minutes before meals. Some people may need 40 to 60 milligrams daily, others only 10 to 15 milligrams. Your doctor will determine the best dose.

Ritalin-SR, Methylin ER, and Metadate ER Tablets

These tablets keep working for 8 hours. They may be used in place of Ritalin tablets if they deliver a comparable dose over an 8-hour period.

CHILDREN

This drug should not be given to children under 6 years of age.

Ritalin and Methylin Tablets

The usual starting dose is 5 milligrams taken twice a day, before breakfast and lunch; your doctor will increase the dose by 5 to 10 milligrams a week. Your child should not take more than 60 milligrams in a day. If you do not see any improvement over a period of 1 month, check with your doctor. He or she may wish to discontinue the drug.

Ritalin-SR, Methylin ER, and Metadate ER Tablets

These tablets continue working for 8 hours. Your doctor will decide if they should be used in place of the regular tablets.

Ritalin LA Capsules

The recommended starting dose is 20 milligrams once daily in the morning. At weekly intervals, the doctor may increase the dose by 10 milligrams, up to a maximum of 60 milligrams once a day.

Concerta Tablets

The recommended starting dose is 18 milligrams once daily in the morning. At weekly intervals, your doctor may increase the dose in 18-milligram steps, up to a maximum of 54 milligrams each morning.

Metadate CD Capsules

The recommended starting dose is 20 milligrams once daily before breakfast. If necessary, the doctor may increase the dose in 20-milligram steps to a maximum of 60 milligrams once a day.

Your doctor will periodically discontinue the drug in order to reassess your child's condition. Drug treatment should not, and need not, be indefinite and usually can be discontinued after puberty.

Overdosage of Ritalin

If you suspect an overdose of Ritalin, seek medical attention immediately.

Symptoms of Ritalin overdose may include: Agitation, confusion, convulsions (may be followed by coma), delirium, dryness of mucous membranes, enlarging of the pupil of the eye, exaggerated feeling of elation, extremely elevated body temperature, flushing, hallucinations, headache, high blood pressure, irregular or rapid heartbeat, muscle twitching, sweating, tremors, vomiting

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Full Ritalin Prescribing Information

Detailed Info on Signs, Symptoms, Causes, Treatments of ADHD

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Important information for patients taking Suboxone, Subutex including impact on fertility, pregnancy and breastfeeding.

Generic name: Combination of buprenorphine and naloxone
Brand name: Suboxone

Pronounced: SUB-ox-own

Additional Suboxone Patient Information
Full Suboxone Prescribing Information

Patients should inform their family members that, in the event of emergency, the treating physician or emergency room staff should be informed that the patient is physically dependent on narcotics and that the patient is being treated with SUBOXONE or SUBUTEX.

Patients should be cautioned that a serious overdose and death may occur if benzodiazepines, sedatives, tranquilizers, antidepressants, or alcohol are taken at the same time as SUBOXONE or SUBUTEX.

SUBOXONE and SUBUTEX may impair the mental or physical abilities required for the performance of potentially dangerous tasks such as driving a car or operating machinery, especially during drug induction and dose adjustment. Patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that buprenorphine therapy does not adversely affect their ability to engage in such activities. Like other opioids, SUBOXONE and SUBUTEX may produce orthostatic hypotension in ambulatory patients.

Patients should consult their physician if other prescription medications are currently being used or are prescribed for future use.

Carcinogenesis, Mutagenesis and Impairment of Fertility:

Carcinogenicity: Carcinogenicity data on SUBOXONE are not available. Carcinogenicity studies of buprenor-phine were conducted in Sprague-Dawley rats and CD-1 mice. Buprenorphine was administered in the diet to rats at doses of 0.6, 5.5, and 56 mg/kg/day (estimated exposure was approximately 0.4, 3 and 35 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis) for 27 months. Statistically significant dose-related increases in testicular interstitial (Leydig's) cell tumors occurred, according to the trend test adjusted for survival. Pair-wise comparison of the high dose against control failed to show statistical significance. In an 86-week study in CD-1 mice, buprenorphine was not carcinogenic at dietary doses up to 100 mg/kg/day (estimated exposure was approximately 30 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis).

Mutagenicity:

SUBOXONE: The 4:1 combination of buprenorphine and naloxone was not mutagenic in a bacterial mutation assay (Ames test) using four strains of S. typhimurium and two strains of E. coli. The combination was not clas-togenic in an in vitro cytogenetic assay in human lymphocytes, or in an intravenous micronucleus test in the rat.

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SUBUTEX: Buprenorphine was studied in a series of tests utilizing gene, chromosome, and DNA interactions in both prokaryotic and eukaryotic systems. Results were negative in yeast (Saccharomyces cerevisiae) for recombinant, gene convertant, or forward mutations; negative in Bacillus subtilis "rec" assay, negative for clastogenici-ty in CHO cells, Chinese hamster bone marrow and spermatogonia cells, and negative in the mouse lymphoma L5178Y assay. Results were equivocal in the Ames test: negative in studies in two laboratories, but positive for frame shift mutation at a high dose (5mg/plate) in a third study. Results were positive in the Green-Tweets (E. coli) survival test, positive in a DNA synthesis inhibition (DSI) test with testicular tissue from mice, for both in vivo and in vitro incorporation of [3H]thymidine, and positive in unscheduled DNA synthesis (UDS) test using testicular cells from mice.

Impairment of Fertility:

SUBOXONE: Dietary administration of SUBOXONE in the rat at dose levels of 500 ppm or greater (equivalent to approximately 47 mg/kg/day or greater; estimated exposure was approximately 28 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis) produced a reduction in fertility demonstrated by reduced female conception rates. A dietary dose of 100 ppm (equivalent to approximately 10 mg/kg/day; estimated exposure was approximately 6 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis) had no adverse effect on fertility.

SUBUTEX: Reproduction studies of buprenorphine in rats demonstrated no evidence of impaired fertility at daily oral doses up to 80mg/kg/day (estimated exposure was approximately 50 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis) or up to 5mg/kg/day im or sc (estimated exposure was approximately 3 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis).

Pregnancy;

Pregnancy Category C: Teratogenic effects:

SUBOXONE: Effects on embryo-fetal development were studied in Sprague-Dawley rats and Russian white rabbits following oral (1:1) and intramuscular (3:2) administration of mixtures of buprenorphine and naloxone. Following oral administration to rats and rabbits, no teratogenic effects were observed at doses up to 250 mg/kg/day and 40 mg/kg/day, respectively (estimated exposure was approximately 150 times and 50 times, respectively, the recommended human daily sublingual dose of 16 mg on a mg/m? basis). No definitive drug-related teratogenic effects were observed in rats and rabbits at intramuscular doses up to 30 mg/kg/day (estimated exposure was approximately 20 times and 35 times, respectively, the recommended human daily dose of 16 mg on a mg/m? basis). Acephalus was observed in one rabbit fetus from the low-dose group and omphacele was observed in two rabbit fetuses from the same litter in the mid-dose group; no findings were observed in fetuses from the high-dose group. Following oral administration to the rat, dose-related post-implantation losses, evidenced by increases in the numbers of early resorptions with consequent reductions in the numbers of fetuses, were observed at doses of 10 mg/kg/day or greater (estimated exposure was approximately 6 times the recommended human daily sublingual dose of 16 mg on a mg/m? basis). In the rabbit, increased post-implantation losses occurred at an oral dose of 40 mg/kg/day. Following intramuscular administration in the rat and the rabbit, post-implantation losses, as evidenced by decreases in live fetuses and increases in resorptions, occurred at 30 mg/kg/day.

SUBUTEX: Buprenorphine was not teratogenic in rats or rabbits after im or sc doses up to 5 mg/kg/day (estimated exposure was approximately 3 and 6 times, respectively, the recommended human daily sublingual dose of 16 mg on a mg/m2 basis), after iv doses up to 0.8 mg/kg/day (estimated exposure was approximately 0.5 times and equal to, respectively, the recommended human daily sublingual dose of 16 mg on a mg/m2 basis), or after oral doses up to 160 mg/kg/day in rats (estimated exposure was approximately 95 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis) and 25 mg/kg/day in rabbits (estimated exposure was approximately 30 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis). Significant increases in skeletal abnormalities (e.g., extra thoracic vertebra or thoraco-lumbar ribs) were noted in rats after sc administration of 1 mg/kg/day and up (estimated exposure was approximately 0.6 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis), but were not observed at oral doses up to 160 mg/kg/day. Increases in skeletal abnormalities in rabbits after im administration of 5 mg/kg/day (estimated exposure was approximately 6 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis) or oral administration of 1 mg/kg/day or greater (estimated exposure was approximately equal to the recommended human daily sublingual dose of 16 mg on a mg/m2 basis) were not statistically significant.

In rabbits, buprenorphine produced statistically significant pre-implantation losses at oral doses of 1 mg/kg/day or greater and post-implantation losses that were statistically significant at iv doses of 0.2 mg/kg/day or greater (estimated exposure was approximately 0.3 times the recommended human daily sublingual dose of 16 mg on a mg/m2 basis).

There are no adequate and well-controlled studies of SUBOXONE or SUBUTEX in pregnant women. SUBOX-ONE or SUBUTEX should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

Non-teratogenic effects.

Dystocia was noted in pregnant rats treated im with buprenorphine 5 mg/kg/day (approximately 3 times the recommended human daily sublingual dose of 16 mg on a mg/m? basis). Both fertility and peri- and postnatal development studies with buprenorphine in rats indicated increases in neonatal mortality after oral doses of 0.8 mg/kg/day and up (approximately 0.5 times the recommended human daily sublingual dose of 16 mg on a mg/m? basis), after im doses of 0.5 mg/kg/day and up (approximately 0.3 times the recommended human daily sublingual dose of 16 mg on a mg/m? basis), and after sc doses of 0.1 mg/kg/day and up (approximately 0.06 times the recommended human daily sublingual dose of 16 mg on a mg/m? basis). Delays in the occurrence of righting reflex and startle response were noted in rat pups at an oral dose of 80 mg/kg/day (approximately 50 times the recommended human daily sublingual dose of 16 mg on a mg/m? basis).

Neonatal Withdrawal:

Neonatal withdrawal has been reported in the infants of women treated with SUBUTEX during pregnancy. From post-marketing reports, the time to onset of neonatal withdrawal symptoms ranged from Day 1 to Day 8 of life with most occurring on Day 1 .. Adverse events associated with neonatal withdrawal syndrome included hyper-tonia, neonatal tremor, neonatal agitation, and myoclonus. There have been rare reports of convulsions and in one case, apnea and bradycardia were also reported.

Nursing Mothers:

An apparent lack of milk production during general reproduction studies with buprenorphine in rats caused decreased viability and lactation indices. Use of high doses of sublingual buprenorphine in pregnant women showed that buprenorphine passes into the mother's milk. Breast-feeding is therefore not advised in mothers treated with SUBUTEX or SUBOXONE.

Pediatric Use:

SUBOXONE and SUBUTEX are not recommended for use in pediatric patients. The safety and effectiveness of SUBOXONE and SUBUTEX in patients below the age of 16 have not been established.

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Additional Suboxone Patient Information
Full Suboxone Prescribing Information

Detailed Info on Signs, Symptoms, Causes, Treatments of Addictions

back to: Psychiatric Medication Patient Information Index

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