KidsPeace believes that it is helpful to our readers to reprint some Healing Magazine articles that are as relevant today as when they were published in our Magazine. This article discusses how communication is so important when doctors prescribe psychotropic medications to children. This article was published in the Spring/Summer 2006 issue.

 

Children’s Psychotropic Medications: Communication is key

 

By Pat Sullivan

 

Millions of children take prescription psychotropic medications to treat a wide range of conditions that can destroy their quality of life. According to Dr. Adnan B. Zawawi, Psychiatrist at KidsPeace Psychiatric Hospital, it is imperative that parents and physicians establish open communication early in a child’s treatment. “At KidsPeace, we provide parents with written information on any medications we might prescribe in the admissions packet so that parents can make informed decisions regarding their children’s treatment. They must give us written consent before we start any medication,” Zawawi says. He also wants to dispel a common myth: “These are not drugs; they are medications. Just as we prescribe medications for hypertension, diabetes or infections, we prescribe medications for illnesses of the mind.”

 

There are several classes of psychotropic medications that are typically prescribed for youth:

Antidepressants

• Tricyclics – Older drugs. These medications (some brand names include Adapin, Elavil, Pamelor and Tofranil) are typically only used when SSRIs (see below) are ineffective.

• SSRIs (Selective Serotonin Reuptake Inhibitors) – Newer antidepressants (some brand names include Prozac, Zoloft, Paxil and Lexapro) used more commonly because they restore deficits in certain neurotransmitters that facilitate communication between brain cells (neurons) and return the brain to normal functioning with few side effects.

 

Dr. Zawawi emphasizes that depression is a serious medical problem that causes the brain to function differently from those of individuals who are not depressed. The benefits of taking antidepressants far outweigh the risks associated with them. Dr. Zawawi also notes that NIH studies have shown that patients treated with a combination of SSRIs and therapy had higher success rates than those taking SSRIs alone or those undergoing therapy alone.

 

Typically, antidepressants are used for a year or two, with cessation being gradual and closely supervised by a physician. One should never abruptly stop antidepressants. Dr. Zawawi emphasizes that starting a child on an antidepressant or other psychotropic medication is a major decision that is based on improving the child’s quality of life, happiness and productivity.

 

Mood Stabilizers

• Lithium – A salt that has been used since the 1970s to treat bipolar disorder, particularly manic episodes; depression while on Lithium may indicate that a higher dosage is needed. It is important to monitor levels of Lithium (some brand names include: Cibalith-S, Eskalith, Lithane, Lithobid, Lithonate and Lithotabs) in the blood stream and to consult with prescribing doctors before taking any medications, including, but not limited to, ibuprofen, antihypertensives, muscle relaxers and diuretics.

• Anticonvulsants – Helpful in controlling mood swings, although their main use is to prevent seizures (some brand names include Depakote, Topamax, Tegetrol, Lamictal and Clonazepam).

• Atypical Antipsychotics – Used alone or in combination with mood stabilizers can be quite effective, although it is very important to use as directed (brands include Abilify, Navene, Risperdal, Seroquel).

 

Bipolar disorders in adults are marked by wide-ranging mood swings from deep depression to unbridled mania, but, according to Dr. Zawawi, children experience fewer “top of the world” highs and deep troughs. Instead, bipolar children are typically irritable, cranky and miserable, with sometimes explosive mood swings that can result in unhappiness, difficulty in school and trouble with the law. “Mood disorders require medication,” Zawawi says. “Lithium is the standard and has been used for a long time, but the atypicals are gaining popularity. All mood stabilizers must be used as directed.”

 

Antipsychotics

• Antipsychotics – Older medications that effectively reduce symptoms of psychosis but can have severe side effects and do not control mood swings (some brands include: Thorazin, Mellaril, Haldol and Prolixin.)

• Atypical Antipsychotics – Very effective in controlling psychosis and mood swings (brands include: Abilify, Zyprexa, Theraciule, Geodan and Clozoril).

 

Psychosis and schizophrenia are serious conditions that cause people to experience visual and auditory hallucinations and delusions. The side effects of some antipyschotics can be very serious, but schizophrenic patients need to take them long term in order to function within society. The two most serious types of side effects, although rare, include: (1) extraperonial symptoms such as rigidity, stiffness, tremors and tardive dyskinesia, which is uncontrollable movement of the mouth, arms and other body parts, and (2) metabolic disorders such as diabetes, high cholesterol and weight gain. Therefore, Dr. Zawawi warns that anyone taking antipsychotics have regular blood sugar, lipid and liver function tests, as well as family history screening and close supervision. Zawawi stresses that doctors are very careful about putting children on these medications and try to use antipsychotics for as short a time period as possible.

 

Psychostimulants

Psychostimulants are used in the treatment of Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) and have been the standard for many years. Zawawi explains that these medications are not addictive and can be used into adulthood to help patients focus and control impulsivity. Although classified as stimulants, these medications (including Ritalin, Concerta and Adderal) have a calming effect on patients who suffer from ADD/ADHD. Side effects may include sleep problems and weight loss, but psychostimulants help children perform better in school, engage in less impulsive behavior, focus on tasks, have more positive social experiences and generally stay out of trouble. Zawawi says that dosage and symptoms should be closely monitored and appropriately adjusted.

 

Anxiolytics

Many children suffer from extreme anxiety and school phobia, which can incapacitate them socially and academically. Medications that treat anxiety are used short term for acute panic attacks because they can be addictive. Anxiety disorders are more frequently treated with SSRIs and therapy, but anxiolytics such as Xanax, Librium, Atavan and Valium can help children through especially difficult periods. Zawawi warns that use of these medications must be closely monitored and carefully tapered off in terms of dosage to prevent withdrawal symptoms.

 

Communication

Dr. Zawawi stresses that parents must communicate with all of the physicians who treat their children regarding prescription and over-the-counter (OTC) medications. “Parents think that they are bothering their doctor with calls to see if it is safe to give decongestants or cough syrup or even pain and fever relievers to their children, but, believe me, we would rather answer your question beforehand than have to treat serious side effects after the fact,” he says. Combining psychotropic medications with others medicines can cause serious and even life-threatening reactions. “Be sure to tell your family physician about any psychotropic medications your child is taking and encourage them to contact the psychiatrist if there are any questions,” Zawawi says. Many psychiatrists monitor a child’s psychotropic medications for a few months and then turn administration over to the family physician, who is more familiar with the child’s history.

 

In general, antibiotics and asthma medications are safe when taken in conjunction with psychotropics, Zawawi explains, but it is still important to report all new prescriptions to all of your child’s doctors. Steroids and birth control pills can cause serious medication interactions with some psychotropics, as can fever reducers and decongestants.

 

Many parents do not realize that herbal and natural supplements can cause severe interactions with psychotropics as well. Dr. Zawawi tells parents that he respects their decisions if they want to try the natural route to treat their children, but herbals should not be taken in combination with any of the psychotropics. Also, parents should not administer larger doses than suggested by the manufacturer of natural or herbal remedies to their children. The adage, “if a little’s good, a lot’s much better” does not apply to natural or herbal supplements.

 

When it comes to alcohol and street drugs, Zawawi is very clear with his patients. He tells them if they combine alcohol and street drugs with their prescribed medications, they can suffer extreme sedation, excessive irritability, seizures or comas. It can truly be a lethal combination.

 

School

It can be difficult to make a decision to inform teachers, counselors and school nurses that a child is taking psychotropic medications. There are several points to keep in mind:

• Most schools do not allow children to carry and take medications of any kind in school. If your child needs mid-day administration, this has to be done by the school nurse, and the medications must be kept under lock and key in the nurse’s office.

• Teachers often spend more waking hours with your child than you do. If they know what your child is taking and the possible side effects or reactions, they can watch for anything out of the ordinary and report to you and the school nurse.

• Investigate confidentiality issues in your school system to increase your comfort level. Having an illness does not mean that your child will be “labeled” or suffer discrimination of any kind. There are laws that protect against this.

• Teachers can make adaptations to accommodate your child’s condition, including reduced homework, tutoring, modified tests, frequent visits to the nurse or rest room, the need to eat more frequently, rest periods in the nurse’s office if overly tired, reduced physical activity, not going outside, etc.

• Often, teachers or school counselors were the first to pick up on your child’s condition and referred him or her for an evaluation in the first place. They are trained to recognize possible problems.

• Teachers can arrange for your child to have a quiet place to go during over-stimulating activities, gym or even lunchtime.

• Your child may be more comfortable knowing that the teacher, nurse or counselor understands what he or she is going through and is approachable if the child does not feel well.

• Teachers can “run interference” if your child is struggling with a social or academic issue and make the situation less stressful.

• Your child may be eligible for placement in a smaller class that better meets his or her needs on a short- or long-term basis.

 

Involvement

Dr. Zawawi stresses the importance of parents being as involved as possible in their children’s treatment, medication, school life and healing. Acknowledging that parents are very busy and often do not have a great deal of time to spend with their children, he says that, at the very least, parents must:

• Monitor and administer their children’s medications

• Communicate regularly with all professionals involved in their children’s treatment

• Spend time with their children to observe and discuss how they are feeling, progressing, regressing, reacting to medication and getting along in school and socially

• Give unconditional love and support.