This book fulfills an urgent need for an updated text on pediatric psychopharmacology. It takes a unique approach in discussing recent findings within the context of current issues, including economic and political ones. The book covers the emerging question of treating children who do not yet meet diagnostic criteria for psychosis, e.g, schizophrenia or bipolar disorder, but who are deemed to be at high risk. This is an active area of debate: such children are being treated in certain centers, while others reject this completely. The book addresses the antidepressant controversy, the placebo response and unique strategies for delineating this, and ways to optimize the differential between active medication and placebo. It reviews the impact of recent American Heart Association guidelines for monitoring children on stimulants and other psychotropics. It adheres closely to DSM-IV diagnostic criteria throughout. The book describes the use of newly approved drugs such as Lexapro for treating adolescent depression and the novel compound Intuniv.
It covers the TADS and CAMS studies, which evaluated the use of SSRIs alone and in combination with cognitive behavioral therapy for adolescent depression. Other topics include treatment of bipolar disorders, the increasing popularity of generic equivalents, combination pharmacotherapy and the potential dangers of psychotropic medications. This is the third edition of the first ever book published on pediatric psychopharmacology from renowned editors. It incorporates current developments with regard to SSRIs, their indications and their safety issues, including possible associated suicidal behavior. It addresses concerns about cardiovascular side effects of the new stimulant medications available, and compares to other FDA-approved medications for ADHD. It features many tables, figures and pictorials, making it highly accessible and reader friendly.
List of Contributors, xv Foreword, xix Chapter 1 Historical Perspectives on Child and Adolescent Psychopharmacology, 1 Samuel Gershon References, 4 Chapter 2 Pharmacoepidemiology of Psychotropic Medications in Youth, 7 Daniel J. Safer & Julie Magno Zito Introduction, 7 Prevalence and trends for medications prescribed for ADHD, 8 Nonstimulant medications for ADHD, 11 Antidepressant medication, 11 Antipsychotic medication, 13 Alpha-agonists, 14 Anticonvulsant "mood stabilizers", 15 Concomitant psychotropic medication, 15 Preschool psychotropic medication use, 17 International patterns of psychotropic medication for youth, 17 Conclusion, 18 References, 18 Chapter 3 Off-Label Prescribing of Drugs in Child and Adolescent Psychiatry, 25 C. Lindsay DeVane Introduction, 25 Extent of off-label prescribing, 27 Need for psychoactive drug treatments for children and adolescents, 31 Legislation supporting pediatric drug development, 33 Recommendations to follow when considering off-label prescribing, 35 References, 36 Chapter 4 The Use of Generic Drugs in Pediatric Psychopharmacology, 39 Richard I. Shader & Christopher-Paul Milne What is a generic drug?, 39 Why are we discussing generic drugs?, 39 Basic requirements for generic drugs, 40 The status of regulations regarding generic drugs and children, 41 Abbreviated new drug application (ANDA) requirements, 42 Pediatric assessments of adult drugs (history up to current status), 43 Best Pharmaceuticals for Children Act, 44 Pediatric Research Equity Act, 45 Intersection of requirements for generics and pediatric assessment, 46 Future directions, 48 Concluding thoughts, 49 References, 49 Chapter 5 Psychoactive Drug Use in Children: Basic Concepts in Clinical Pharmacology, 51 David J. Edwards Introduction, 51 Basic concepts in pharmacokinetics, 52 Dosing considerations for psychoactive drugs in children, 55 Summary, 60 References, 60 Chapter 6 Psychostimulants, 65 Steven R. Pliszka Introduction, 65 Epidemiology of stimulant use, 66 Structure and biochemical mechanism of action, 66 Neuroimaging studies of stimulant effects, 67 Studies of short-term efficacy, 72 Studies of long-term efficacy, 76 Clinical use, 79 Common side-effects, 84 Cardiovascular safety issues, 86 Growth suppression, 88 Substance use and diversion, 88 Comparison with nonstimulant treatment, 89 Treatment of comorbidity, 92 Pharmacogenetics, 93 Conclusions, 94 References, 94 Chapter 7 Tricyclic Antidepressants and Monoamine Oxidase Inhibitors for the Treatment of Child and Adolescent Psychiatric Disorders, 105 Charlotte M. Heleniak, Tejal Kaur, Kareem D. Ghalib & Moira A. Rynn Tricyclic antidepressants (TCAs), 105 Drug interactions, contraindications, 116 Monoamine oxidase inhibitors (MAOIs), 117 General summary, 122 References, 123 Chapter 8 Selective Serotonin Reuptake Inhibitors (SSRIs), 131 Dara Sakolsky & Boris Birmaher Pharmacokinetics, 131 Initiation and titration, 133 Indications and efficacy, 134 Adverse effects, 146 Withdrawal, 149 References, 149 Chapter 9 Novel (Atypical) Antidepressants, 155 Heidi R. Bruty, Graham J. Emslie & Paul Croarkin Novel (atypical) antidepressants, 155 General overview, 155 Bupropion, 157 Duloxetine, 162 Mirtazapine, 164 Trazodone, 166 Venlafaxine, 170 Desvenlafaxine, 173 Alternative treatments, 174 Summary, 175 References, 176 Chapter 10 Antipsychotic Agents, 181 Brieana M. Rowles, John L. Hertzer & Robert L. Findling Introduction, 181 Chemical properties, 182 Typical antipsychotics, 183 Atypical antipsychotics, 186 Ethical issues: treatment of at-risk populations, 212 Conclusions, 213 References, 213 Chapter 11 Lithium, 221 Garrett M. Sparks & David A. Axelson Introduction, 221 Pharmacology, 222 Potential mechanisms of action, 222 Evidence for the use of lithium in children and adolescents, 232 Dosing and drug monitoring, 239 Contraindications, precautions, and drug interactions, 242 Side-effects, 246 References, 250 Chapter 12 Anticonvulsants Used in Child and Adolescent Psychiatric Disorders, 261 Mani Pavuluri & Tushita Mayanil Introduction, 261 Divalproex sodium, 261 Carbamazepine, 271 Oxcarbazepine, 275 Lamotrigine, 279 Gabapentin, 284 Topiramate, 285 Conclusion, 288 References, 288 Chapter 13 Anxiolytics, 301 Barbara J. Coffey & Amanda L. Zwilling Chemical properties, 301 Indications, 305 Contraindications, 320 Adverse effects, 321 Overdose, 324 Abuse/dependence, 324 Drug interactions, 325 Available preparations and cost, 325 Initiation and maintenance of treatment, 325 Management of specific side-effects, 330 How to withdraw medication, 332 References, 332 Chapter 14 Adrenergic Agents in Child and Adolescent Psychiatry, 341 Lawrence David Scahill Clonidine and guanfacine, 341 Guanfacine, 349 Beta-blockers, 355 Acknowledgements, 361 References, 361 Chapter 15 Atypical Psychopharmacologic Strategies, 365 Jess Shatkin & Aron Janssen Opiate antagonists, 365 Memantine, 368 Riluzole, 369 Secretin, 371 Topiramate, 372 Herbal medications and dietary supplements, 373 Ginkgo ( Ginkgo biloba ), 375 Melatonin, 381 Omega-3 fatty acids, 383 St. John's wort ( Hypericum perforatum ), 384 Valerian ( Valeriana officinalis ), 387 Conclusion, 388 References, 389 Chapter 16 Psychopharmacology in Preschool Children, 399 Mini Tandon & Joan Luby Introduction, 399 Developmental considerations, 400 Rise in psychopharmacology use, 402 Psychotherapy before psychopharmacology, 403 When psychopharmacology may be considered as a first line: pragmatic considerations, 404 Psychopharmacology in preschool disorders: administration and monitoring, 404 Off-label prescribing: special considerations, 407 Use of psychotropics in specific disorders, 408 Summary, 415 References, 415 Chapter 17 Combination Pharmacotherapy for Psychiatric Disorders in Children and Adolescents, 421 Gagan Joshi & Anna M. Georgiopoulos Bipolar disorder, 422 Major depressive disorder, 429 Attention-deficit hyperactivity disorder, 431 Obsessive-compulsive disorder, 433 Tics and Tourette's syndrome, 434 Pervasive developmental disorders, 434 Conclusion, 434 References, 435 Index, 439