The medication information handouts in this book are intended for use in the context of clinical psychiatric evaluation and treatment of children and adolescents. The purpose of these handouts is to share basic information about medications with parents, teachers, and adolescent patients. The information sheets, especially the ones for youth, do not cover all possible side effects and are not intended for use as informed consent documents. They do not include educational information about disorders. Suggested resources are provided in the pages following this introduction, preceding the medication information sheets. The medication information sheets should be used by prescribing physicians with patients (who are old enough to read and understand them) and families to supplement an ongoing dialogue regarding the indications for medications, medication effects, and side effects. The sheets are not meant to be guides for physicians in prescribing medicine but rather to be used once the decision is made to prescribe a particular medication for a particular patient. The sheets are valuable for teachers (and school nurses) in helping understand the medications used by students. In our clinical practice at Children's Memorial Hospital, nonphysician mental health professionals have found these sheets to be useful when proposing to patients and families an evaluation for possible medication.
Information on each medication in this third edition has been completely updated from the second edition (published in 2003). New medications, such as atomoxetine (Strattera) and aripiprazole (Abilify) have been added. Medications taken off the market, such as pemoline (Cylert) and nefazodone (Serzone), have been removed. New concerns about potential side effects and U.S. Food and Drug Administration (FDA) black box warnings (for antidepressants and stimulants) have been addressed. Coverage of medications used for sleep has been expanded. The book has been entirely restructured, using the format of a combined adult information sheet (“Medication Information for Parents and Teachers”) followed by an information sheet specifically for youth. Each medicine now has its own sheet instead of being grouped by drug category as in the second edition. The medications are listed alphabetically by their generic names. The various formulations of stimulant medications have been placed in two sets of group information sheets by the active ingredient, methylphenidate or amphetamine. It is always a dilemma whether to focus on generic names or brand names. In this edition, we have chosen to use the generic names more often, because more medications are going off-patent and have more formulations and also to minimize the commercial focus. As before, we use only U.S. brand names.
New to this edition, appendices list medications typically used for certain indications, in case the clinician wishes to discuss options with the family or to check off which medications have been tried as he or she reviews the patient's medication history with the family. The information on additional mental health resources—books, journals, newsletters, and Internet sites—has been updated.
We have not included some medications (like monoamine oxidase inhibitors or cognitive enhancers) that are virtually never used for youth because of unacceptable side-effect profiles and/or lack of evidence for efficacy. For medications not included in this book, or for more sophisticated and detailed information targeted at highly educated “consumers,” an excellent resource is What Your Patients Need to Know About Psychiatric Medications, by Hales, Yudofsky, and Chew (American Psychiatric Publishing 2005). The format and intended use are the same as this book, but the target audience is psychiatrists caring for adult patients. Handouts for adults on major psychiatric illnesses, along with information targeted at adult patients and families on groups of psychiatric medications, can be found in Wyatt's Practical Psychiatric Practice: Forms and Protocols for Clinical Use, Third Edition, by Wyatt and Chew (American Psychiatric Publishing 2005).
All of the contributors to this book are experienced child and adolescent psychiatrist clinicians who use psychopharmacology as one component of comprehensive mental health treatment of children and adolescents. In the years since the publication of the second edition, we have found that many families have become more sophisticated about psychotropic medications due to increasingly available helpful information from patient–professional advocacy groups and more dramatic but less helpful attention from the media. In response to these developments, we have somewhat increased the complexity of the information sheets. This decision must always be weighed against the reality of different reading levels in order for the information sheets to be accessible to the largest possible audience of patients and families. We hope that we have found the right balance. For brevity and readability, many details and much explanation have been omitted, as well as rare or poorly documented side effects. Each physician is likely to disagree with some aspect of what we have written. The handouts are offered as a resource to those who find them useful, not as a standard for psychopharmacology practice. Only the most common indications are included. If a specific indication has been omitted, that does not necessarily mean that it is inappropriate.
The information provided in these sheets is based on the available scientific literature and the clinical experience of the authors and their colleagues. Unfortunately, most psychopharmacology research is performed on adults, not children and adolescents, although a slight improvement—more research on psychopharmacology for children and adolescents—has occurred in recent years. Many of the indications for medication have not received FDA approval and therefore are not listed in the Physicians' Desk Reference (PDR). However, once a drug is approved for any indication, the FDA regulates only the company's advertising of the drug, not what physicians may prescribe. Nearly all psychopharmacological agents and indications (and the majority of the drugs used in pediatrics, as well) lack pediatric labeling and are “unapproved” or “off-label” for use in children. Off-label use may be accepted practice, appropriate, and rational. However, the FDA guidelines as published in the PDR cannot be relied on for appropriate indications, age ranges, or dosages for children. Sources such as the PDR are increasingly available to lay consumers, making the information in this book even more necessary. Lack of FDA approval for an age group or a disorder does not imply improper or illegal use. As a result of pressure from the FDA and new financial incentives (via extending the patent on drugs), pharmaceutical companies have increased their attention to research in children. The Best Pharmaceuticals for Children Act mandates that for any drug that receives pediatric exclusivity (i.e., 6-month extension of patent exclusivity), the manufacturer must submit data to the FDA on all pediatric adverse-event reports for 1 year following the granting of extended exclusivity. This requirement, in addition to applications for new indications, has increased the opportunities for discussion of potential side effects. However, while knowledge of potential risks is clearly beneficial, the resulting FDA hearings and advisory committee meetings have given antipsychiatry groups, such as the Citizens Commission on Human Rights and the Alliance for Human Research Protection, highly visible opportunities for testimony opposing psychiatric medications and even questioning the validity of diagnoses. Unfortunately, this attention to supposed side effects, fueled by attention from the media and plaintiff attorneys, has frightened parents and some physicians and is also likely to dampen industry enthusiasm to pursue needed research in pediatric psychopharmacology. The National Institute of Mental Health budget is unlikely to allow for the large, long-term studies needed to assess efficacy and safety. In the meantime, practitioners must do the best they can to help children and families struggling with mental illness, using the available evidence, good clinical judgment, and appropriate caution.