Citation

Giles LL, Martini DR. Acad. Pediatr. 2016; 16(6): 508-518.

Affiliation

Departments of Pediatrics and Psychiatry, University of Utah School of Medicine; Department of Psychiatry and Behavioral Health, Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113.

Copyright

(Copyright © 2016, Academic Pediatric Association, Publisher Elsevier Publishing)

DOI

10.1016/j.acap.2016.03.011

PMID

27064142

Abstract

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. This paper reviews 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 ADHD. 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 antipsychotics in youth with bipolar mania and autistic disorder has grown. Most concerning with antipsychotics are the metabolic side effects that appear even more problematic in youth then adults. By better understanding the evidence-based psychopharmacologic interventions, academic pediatricians will be able to treat and prepare future pediatrician to address the growing mental health care needs of youth.

Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Language: en