The evidence for the use of medications in children and adolescents to treat mental disorders has significantly improved over the past several years. Large national multicenter comparative treatment trials sponsored by the National Institute of Mental Health for ADHD, Anxiety disorders- Obsessive Compulsive Disorders, Generalized Anxiety Disorders, Separation Anxiety Disorders and Depression have given us confidence in the safety, efficacy and tolerability of the selective serotonin reuptake inhibitors, stimulants and now alpha 2 agonists. The role that these medications have in combination with cognitive behavioral therapies has also been well proven to enhance and speed up the rate of recovery. Despite these important advances in the treatments for childhood disorders, the evidence is based on group responses. We are not yet able to specifically tell on an individual basis which children/adolescents will respond best to what type of treatment. There are many nonspecific factors that will influence a good response to caring treatment offered by well trained and experienced clinicians. Paying close attention to positive influences and protective supports to provide a strengths based approach to a child’s treatment is important to the success of any treatment offered.
Because of the complex nature of the evidence used to make recommendations for the use of psychotropic medications in treating mental disorders a model for shared decision is important to achieve a collaborative approach, which is needed for an active, informed role in understanding and deciding about the use of medications. I fully endorse this model and have learned over the years as a researcher and practicing child psychiatrist that a treatment, no matter scientifically valid, will not work unless it is accepted with confidence as a necessary part of the effort to restore well being and normal development. Getting a full dose and course of treatment is an essential part of getting quality care. Making the commitment to a full course of treatment is not an easy thing to do and really does require a positive expectation that the effort will be worth it.
Finally, it is also important to acknowledge and address the highly publicized warnings from the Federal Drug Administration in the form of Black Box Warnings. A black box warning is named for the black border surrounding the text of the warning that appears on the package insert, label, and other literature describing the medication (e.g., magazine advertising). It is the most serious medication warning required by the FDA. The FDA requires a black box warning for one of the following situations:
· The medication can cause serious undesirable effects (such as a fatal, life-threatening or permanently disabling adverse reaction) compared to the potential benefit from the drug. Depending on your health condition, you and your doctor would need to decide if the potential benefit of taking the drug is worth the risk.
· A serious adverse reaction can be prevented, reduced in frequency, or reduced in severity by proper use of the drug. For example, a medication may be safe to use in adults, but not in children. Or, the drug may be safe to use in adult women who are not pregnant.
The FDA requires the boxed warning to provide a concise summary of the adverse side effects and risks associated with taking the medication. You and your doctor need to be aware of this information when deciding to start the drug or if you should switch to another medication altogether. Understanding side effects will help you make a better informed decision.
Black Boxed warnings are often given to classes of medications since many different medications with similar chemical structures can cause a similar type of serious adverse effect. In child psychiatry many of the medications currently carry a black box warning: Stimulants, Anti-depressants, Second Generation (Atypcal) Anti-psychotics and Anti-epileptic medications. It is therefore imperative that careful medical screening and ongoing systematic monitoring for the emergence of any side effects be done with follow up visits and use of side effect rating scales.
ADHD and Anti-depressant Medication Guides have been developed to assist parents in their understanding of the risks and benefits of these medications. You will find pdf files of these guidelines on this web page for your use.
You can expect at your initial and subsequent visits with a child-psychiatrist at Triangle Center for Behavioral Health a careful and individual review of these issues as part of the recommendations for the use of psychotropic medication.
Your safety and the safety of your child are a primary concern.
Practices Providing This Service:
Allan Chrisman: Durham office