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cont. from
Special Considerations
Children, the
elderly, and
pregnant and nursing women have special concerns and needs when taking
psychotherapeutic medications. Some effects of medications on the growing body,
the aging body, and the childbearing body are known, but much remains to be
learned. Research in these areas is ongoing.
Children
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Suicidality in Children and Adolescents —
Antidepressants increased the risk of suicidal thinking and behavior (suicidality)
in short-term studies in children and adolescents with major depressive
disorder (MDD) and other psychiatric disorders. Anyone considering the
use of any antidepressant in a child or adolescent
must balance this risk with the clinical need. Patients who are started
on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers
should be advised of the need for close observation and communication
with the prescriber. Most antidepressants (except Prozac) are not approved for use in pediatric
patients. Pooled analyses
of short-term (4 to 16 weeks) placebo-controlled trials of 9
antidepressant drugs (SSRIs and others) in children and adolescents with
major depressive disorder (MDD), obsessive compulsive disorder (OCD), or
other psychiatric disorders (a total of 24 trials involving over 4400
patients) have revealed a greater risk of adverse events representing
suicidal thinking or behavior (suicidality) during the first few months
of treatment in those receiving antidepressants. The average risk of
such events in patients receiving antidepressants was 4%, twice the
placebo risk of 2%. No suicides occurred in these trials.
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Studies consistently show that about 15 percent of the US population
below age 18, or over 9 million children, have been diagnosed with a
psychological problem that compromises their ability to function. In children,
these disorders may present symptoms that are different or less clear-cut than
the same disorders in adults. Younger children, especially, may not talk about
what's bothering them, but this is sometimes a problem with older children as
well. For this reason, having both a physician and psychologist evaluate the
child is especially important.
There are many psychological treatments that can help children. These include
psychotherapy,
behavioral therapy, social skills training, parental and family
therapy, group therapy and medications. The treatment, or combination of
treatments, used for an individual child is based on the child's diagnosis and
individual needs. When your child appears to have a psychological problem, it is
very important to consult with a psychologist to determine what should be done.
If a decision is reached that a child should take medication, active
monitoring by all caretakers (parents, teachers, others who have charge of the
child) is essential. Children should be watched and questioned for side effects
(many children, especially younger ones, do not volunteer information). They
should also be monitored to see that they are actually taking the medication and
taking the proper dosage.
The use with children of the medications described here is more limited than
with adults. In the list of medications, those that have specific indications
and dose guidelines for children, as listed in the Physicians' Desk Reference,
are indicated by a double asterisk (**).
The Elderly
Persons over the age of 65 make up 12 percent of the population
of the United States, yet they receive 30 percent of prescriptions filled. The
elderly generally have more medical problems and often are taking medications
for more than one of these problems. In addition, they tend to be more sensitive
to medications. Even healthy older people eliminate some medications from the
body more slowly than younger persons and therefore require a lower or less
frequent dosage to maintain an effective level of medication.
The elderly may sometimes accidentally take too much of a medication because
they forget that they have taken a dose and take another dose. The use of a
7-day pill box is especially helpful to an elderly person.
The elderly, their friends, relatives, and caretakers, need to watch for
adverse (negative) physical and psychological responses to medication. Because
the elderly often take more medications (prescribed, over-the-counter drugs, and
home or natural remedies), the possibility of negative drug interactions is
higher.
Pregnant, Nursing, or Childbearing-Age Women
In general, during pregnancy,
all medications (including psychotherapeutic medications) should be avoided
where possible, and other methods of treatment should be tried.
A woman who is taking a psychotherapeutic medication and plans to become
pregnant should discuss her plans with her doctor; if she discovers that she is
pregnant, she should contact her doctor immediately. During early pregnancy,
there is a possible risk of birth defects with some of these medications, and
for this reason:
- Lithium is not recommended during the first 3 months of pregnancy.
- Benzodiazepines are not recommended during the first 3 months of
pregnancy.
The decision to use a psychotherapeutic medication should be made only after
a careful discussion with the doctor concerning the risks and benefits to the
woman and her baby. Small amounts of medication pass into the breast milk; this
is a consideration for mothers who are planning to breast-feed.
A woman who is taking birth-control pills should be sure that her doctor is
aware of this. The estrogen in these pills may alter the breakdown of
medications by the body, and/or reducing their efficacy to relieve symptoms of
anxiety.
For more information, talk to your doctor or psychologist, consult your local
public library, or write to the pharmaceutical company that produces the
medication or contact:
US Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857.
next:
Names of Antidepressants and
Questions for Your Doctor
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Reviewed: 01/2006
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