Psych · Child and adolescent psychiatry — psychopharmacology
Paediatric psychopharmacology
Also known as Pediatric psychopharmacology · Child and adolescent psychotropic medication · Youth psychopharmacology · CAP prescribing · SSRI black-box children · ADHD medication children · Antipsychotic metabolic monitoring youth · Gillick competence medication
Exam-exhaustive fellowship reference on paediatric psychopharmacology — developmental PK/PD, when to medicate, SSRI black-box communication and youth dosing, ADHD stimulants and non-stimulants with growth/CV monitoring, antipsychotic metabolic risk (Correll, TEOSS), ASD irritability (RUPP), consent/capacity with parents (Gillick), emergency adverse effects, and landmark CAP trials (TADS, CAMS, MTA, Cipriani, Cortese). Distinct from adult drug monographs and single-disorder hubs. FRANZCP-primary, globally tagged.
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Target exams
FRANZCPMRCPsychABPNMD-DNBNEET-SS
Red flags
- New or worsening suicidal ideation, agitation, or akathisia after starting or increasing an antidepressant — reassess risk and care intensity the same day; do not treat black-box fear by abandoning indicated care without a safety plan
- Chest pain, syncope, or new cardiac symptoms on stimulants or atomoxetine — hold the agent and arrange medical/cardiac review
- Rapid weight gain, polyuria/polydipsia, or suspected diabetic ketoacidosis after antipsychotic start — urgent metabolic work-up
- Acute dystonia, NMS features (rigidity, fever, autonomic instability), or severe serotonin toxicity — emergency medical pathway
- Promising absolute confidentiality when safety requires carer involvement for means restriction or observation after a psychotropic start
- Abrupt stop of prolonged guanfacine or clonidine — rebound hypertension risk; taper
Meet the patient
A 14-year-old with three months of worsening depression is in clinic with both parents. The mother has printed the FDA black-box warning and asks, point-blank, whether the tablet will make her daughter suicidal. The registrar reaches for a different drug. The examiner wants the conversation that earns the prescription.[1][14][21]
The question is never "which SSRI". It is "how do you prescribe this safely across classes in a young person, with consent, monitoring and an exit plan?" Everything below answers that.[14][15][20]
References25ShowHide
- [1]Hammad TA, Laughren T, Racoosin J Suicidality in pediatric patients treated with antidepressant drugs Arch Gen Psychiatry, 2006.PMID 16520440
- [2]March J, Silva S, Petrycki S, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial JAMA, 2004.PMID 15315995
- [3]Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial JAMA, 2008.PMID 18314433
- [4]Cipriani A, Zhou X, Del Giovane C, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis Lancet, 2016.PMID 27289172
- [5]Emslie GJ, Heiligenstein JH, Wagner KD, et al. Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial J Am Acad Child Adolesc Psychiatry, 2002.PMID 12364842
- [6]Goodyer I, Dubicka B, Wilkinson P, et al. Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial BMJ, 2007.PMID 17556431
- [7]Walkup JT, Albano AM, Piacentini J, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety N Engl J Med, 2008.PMID 18974308
- [8]The MTA Cooperative Group A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD Arch Gen Psychiatry, 1999.PMID 10591283
- [9]Cortese S, Adamo N, Del Giovane C, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis Lancet Psychiatry, 2018.PMID 30097390
- [10]Cooper WO, Habel LA, Sox CM, et al. ADHD drugs and serious cardiovascular events in children and young adults N Engl J Med, 2011.PMID 22043968
- [11]Sikich L, Frazier JA, McClellan J, et al. Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study Am J Psychiatry, 2008.PMID 18794207
- [12]Correll CU, Manu P, Olshanskiy V, et al. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents JAMA, 2009.PMID 19861668
- [13]McCracken JT, McGough J, Shah B, et al. Risperidone in children with autism and serious behavioral problems N Engl J Med, 2002.PMID 12151468
- [14]Birmaher B, Brent D, Bernet W, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders J Am Acad Child Adolesc Psychiatry, 2007.PMID 18049300
- [15]Pliszka S; AACAP Work Group on Quality Issues Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder J Am Acad Child Adolesc Psychiatry, 2007.PMID 17581453
- [16]Michelson D, Allen AJ, Busner J, et al. Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study Am J Psychiatry, 2002.PMID 12411225
- [17]Sallee FR, McGough J, Wigal T, et al. Guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder: a placebo-controlled trial J Am Acad Child Adolesc Psychiatry, 2009.PMID 19106767
- [18]Graham J, Banaschewski T, Buitelaar J, et al. European guidelines on managing adverse effects of medication for ADHD Eur Child Adolesc Psychiatry, 2011.PMID 21042924
- [19]Cortese S, Holtmann M, Banaschewski T, et al. Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents J Child Psychol Psychiatry, 2013.PMID 23294014
- [20]Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391
- [21]Cheung AH, Zuckerbrot RA, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management Pediatrics, 2018.PMID 29483201
- [22]Hennissen L, Bakker MJ, Banaschewski T, et al. Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine CNS Drugs, 2017.PMID 28236285
- [23]Newcorn JH, Kratochvil CJ, Allen AJ, et al. Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response Am J Psychiatry, 2008.PMID 18281409
- [24]Biederman J, Boellner SW, Childress A, et al. Lisdexamfetamine dimesylate and mixed amphetamine salts extended-release in children with ADHD: a double-blind, placebo-controlled study Biol Psychiatry, 2007.PMID 17631866
- [25]Jain R, Segal S, Kollins SH, et al. Clonidine extended-release tablets for pediatric patients with attention-deficit/hyperactivity disorder J Am Acad Child Adolesc Psychiatry, 2011.PMID 21241954