Children, teens, and the safety of psychotropic medicines

Medicines prescribed for attention deficit/hyperactivity disorder (ADHD), depression, anxiety, and other mood disorders — known as psychotropic drugs — have largely been studied in adults. This concerns many parents whose children take these drugs regularly. Studies have most often looked at the effectiveness of these medicines in teens and children. Now a recent systematic review of multiple studies done in children and adolescents offers new guidance on safety for commonly used medicines.

What did the study look at?

The aim of this study was to comprehensively synthesize current evidence on the safety of four major classes of psychotropic drugs given to children and adolescents. This helps clinicians make decisions when prescribing, and assists in developing well-grounded guidelines. It also helps identify areas needing further research.

What are the take-home messages for parents?

The researchers focused on adverse events, such as side effects or other problems, linked to 80 medicines in four categories: antidepressants, antipsychotics, anti-ADHD medications, and mood stabilizers. Altogether, the studies considered data from 337,686 children and teens. Most study participants were taking either anti-ADHD medicines or antidepressants (roughly 149,000 and 121,000, respectively). Smaller numbers took antipsychotics or mood stabilizers (roughly 67,000 and 1,600).

The study looked at safety profiles and common side effects, which were available in the scientific literature for some, but not all of the medicines: 18 antidepressant medicines; 15 antipsychotic medicines; seven anti-ADHD medicines; and six mood stabilizers. While side effects were modest overall, the researchers found the following:

• Antidepressants. Common issues were nausea, vomiting, and stopping a drug due to side effects. Escitalopram (Lexapro) and fluoxetine (Prozac) were less likely than others to cause adverse effects.
• Antipsychotic medicines. Common issues were drowsiness, abnormal muscle movements, and weight gain. Lurasidone (Latuda) was less likely than others to cause adverse effects.
• Anti-ADHD medicines. Common issues were loss of appetite and insomnia. Methylphenidate (Ritalin, Concerta) was less likely than others to cause adverse effects.
• Mood stabilizers. Common issues were drowsiness and weight gain. Lithium was less likely to cause adverse effects, although its long-term effects, such as possible harm to the kidneys, might be underrepresented.

What are the limitations of this study?

The authors acknowledge that there were limited data about adverse events for many of these medications. Therefore, a more comprehensive reporting of adverse events is necessary in future research on the use of psychotropic medications in children and adolescents. Additionally, long-term and rare side effects are likely underrepresented here, due to the limited availability of longer-term data.

What should I ask if a doctor says my child may need a psychotropic medication?

• What is this medication for? Surprisingly, I’ve talked to a number of parents who aren’t sure why their child is being treated with medication. Make sure you clearly understand several points: what is the diagnosis that requires treatment, and what behavioral symptoms might the medicine help with? Ask if this treatment is approved by the FDA for this diagnosis, or if the doctor is recommending it for off-label use. If you find the discussion confusing, don’t hesitate to ask your doctor to break down or repeat some of the explanations. You may also ask for additional resources, such as educational handouts or websites related to your child’s condition.
• Is this the only medication option available? As described in this study, each psychotropic medication has a unique profile for side effects and effectiveness. This can differ even within the same medication category. Typically, a variety of treatment options are available, either as single drugs or combined with other drugs. Ask about the rationale behind choosing each option, as well as its potential benefits and risks.
• What are the potential side effects? Going over every single possible side effect of each prescribed medication may not be practical, because the list may be long and could create unnecessary anxiety. Instead focus on common and important potential side effects, such as FDA black box warnings. Many teens find it hard to take medications regularly, so ask if there are any important withdrawal effects (in case your child ends up skipping medications).
• How long should my child stay on this medication? This is probably one of the most popular questions that comes up, especially when a youth starts psychotropic medications for the first time. Nobody wants their children to stay on medications indefinitely. Ask your doctor about the recommended duration of treatment. Although none of us can predict the future, it’s a good idea to discuss proposed treatment plans.
• What else should you understand? Some psychotropic medications require specific monitoring protocols to ensure safety. Examples might involve checking blood pressure, tracking body weight and body mass index (BMI), or having blood tests at specific times. Also ask your doctor if you need to be aware of any restrictions, such as avoiding certain foods or other medications.

Medicine is one tool in the toolbox

While medication is one of the stronger treatment tools in mental health care, it’s not the only one. Especially for children and teens, it is essential to approach behaviors holistically by considering biology, psychology, and social and environmental factors. Frequently, medication is combined with other approaches, such as individual therapy, family therapy, and multidisciplinary, system-based approaches like developing an IEP (individualized education program) for school. A comprehensive assessment can guide the care team in making appropriate plans aimed at an optimal outcome.

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