Challenges and Promises of Pediatric Psychopharmacology

Apr 12, 2016Academic pediatrics

Difficulties and Opportunities in Using Medicines to Treat Mental Health in Children

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Abstract

Psychostimulants are supported by a robust body of literature as first-line treatment for attention-deficit/hyperactivity disorder in youth.

Selective serotonin reuptake inhibitors (SSRIs) show documented efficacy for pediatric depression and various childhood-onset anxiety disorders.
Combining cognitive-behavioral therapy with SSRIs may enhance treatment benefits and minimize medication side effects.
Evidence supporting mood stabilizers, such as lithium and anticonvulsants, is less robust and they are associated with problematic side effects.
Antipsychotics have established use in treating childhood-onset schizophrenia, with growing evidence for their use in bipolar mania and autistic disorder.
Metabolic side effects of antipsychotics may be more problematic in youth compared to adults.

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Most prescriptions for psychotropic medications are written by primary care physicians, yet pediatricians, many of whom are teaching residents and medical students about pediatric psychopharmacology, often feel inadequately trained to treat mental health concerns. Over the past several decades, the number, size, and quality of psychopharmacologic studies in youth has greatly increased. Here we review the current evidence for efficacy and safety of each of the major pharmacologic drug classes in youth (psychostimulants, antidepressants, mood stabilizers, and antipsychotics). Psychostimulants have a robust body of literature supporting their evidence as first-line treatment for attention-deficit/hyperactivity disorder. Selective serotonin reuptake inhibitors (SSRIs) have documented efficacy for pediatric depression and multiple different anxiety disorders with childhood onset. Combining cognitive-behavioral therapy with SSRI treatment enhances treatment benefit and minimizes adverse events of medication. Mood stabilizers, including lithium and anticonvulsant medications, have a less robust strength of evidence and come with more problematic side effects. However, they are increasingly prescribed to youth, often to treat irritability, mood lability, and aggression, along with treatment of bipolar disorder. Antipsychotics have long been a mainstay of treatment for childhood-onset schizophrenia, and in recent years, the evidence base for providing antipsychotics to youth with bipolar mania and autistic disorder has grown. Most concerning with antipsychotics are the metabolic side effects, which appear even more problematic in youth than adults. By better understanding the evidence-based psychopharmacologic interventions, academic pediatricians will be able to treat patients and prepare future pediatrician to address the growing mental health care needs of youth.

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Challenges and Promises of Pediatric Psychopharmacology

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