Pediatric Psychopharmacology: Commonly Used Medications in Children

2018 ◽  
Author(s):  
Lawrence Scahill ◽  
Jaimie Rojas
Keyword(s):  
Clinical Trials ◽  
Psychotropic Drugs ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Atypical Antipsychotics ◽  
National Institutes Of Health ◽  
Pharmaceutical Companies ◽  
Federal Policies ◽  
Risks And Benefits ◽  
Drug Classes

Pediatric psychopharmacology is a relatively young field. Through the decade of the 1990s and into the early 2000s, there was an unprecedented increase in the number of new psychotropic drugs and new formulations of older drugs. During this period, there was also a series of well-intended federal policies that provided pressure and incentives for pharmaceutical companies to conduct studies of new medications in children. The National Institutes of Health also provided funding for investigator-initiated clinical trials. Although still less than optimal, we now have a body of data on stimulants, selective serotonin reuptake inhibitors, and atypical antipsychotics. These three psychotropic drug classes are the most commonly used in children and adolescents. This chapter charts the rise in use of these drug classes and presents their risks and benefits.

The Impact of Trends in Psychotropic Prescribing on the Method of Suicide in the Elderly

2005 ◽  
Vol 45 (2) ◽  
pp. 115-120 ◽  
Author(s):  
Ajit Shah ◽  
Lubbaba Lodhi
Keyword(s):  
Psychotropic Drugs ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
The Elderly ◽  
Serotonin Reuptake Inhibitors ◽  
Prescribing Patterns ◽  
Selective Serotonin ◽  
Hypnotics And Sedatives ◽  
Suicide Rates ◽  
Elderly Suicide

Suicide rates in the elderly have declined in many countries in recent years. This decline has been reported to be associated with increased prescribing of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), antipsychotics and antimanic drugs and reduced prescribing of barbiturates, hypnotics and sedatives. This study examined the relationship between prescribing patterns of individual psychotropic drugs and suicide rates by specific methods of elderly suicides. There was a negative correlation between the prescription of tricyclic antidepressants, selective serotonin reuptake inhibitors, antipsychotics, antimanic drugs and non-opiate analgesics and a decline in elderly suicide rates due to poisoning by solid and liquid substances, hanging, strangulation and suffocation, drowning, firearms and explosives, and jumping from high places. There was a positive correlation between the prescription of barbiturates, hypnotics and sedatives and elderly suicide rates due to poisoning by solid and liquid substances, hanging, strangulation and suffocation, drowning, firearms and explosives, and jumping from high places. This study demonstrated that changes in prescribing patterns of individual psychotropic drugs do influence elderly suicide rates of the commonly used methods of suicide and suggest that this may be due to more accurate diagnostic-specific prescribing of psychotropic drugs.

scholarly journals Selective serotonin reuptake inhibitors and pregnancy: A review of maternal, fetal and neonatal risks and benefits

2013 ◽  
Vol 6 (4) ◽  
pp. 155-158 ◽  
Author(s):  
Zbigniew Marchocki ◽  
Noirin E Russell ◽  
Keelin O’ Donoghue
Keyword(s):  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Childbearing Age ◽  
Pharmacological Interventions ◽  
Risks And Benefits ◽  
Potential Risks ◽  
Psychiatric Conditions ◽  
In Pregnancy

Depression is common in women of childbearing age. Whereas non-pharmacological interventions are recommended as first line interventions, pharmacological treatment may be required. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants in pregnancy. Ideally, discussion of the risks and benefits of SSRI use in pregnancy should occur prior to pregnancy. The potential risks of psychotropic medications need to be balanced against the risks associated with untreated psychiatric conditions and the discontinuation of necessary medications.

scholarly journals DESIGNING DRUG TRIALS FOR SARCOPENIA IN OLDER ADULTS WITH HIP FRACTURE – A TASK FORCE FROM THE INTERNATIONAL CONFERENCE ON FRAILTY AND SARCOPENIA RESEARCH (ICFSR)

2014 ◽  
pp. 1-6
Author(s):  
B. VELLAS ◽  
R. FIELDING ◽  
R. MILLER ◽  
Y. ROLLAND ◽  
S. BHASIN ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Hip Fracture ◽  
Diagnostic Criteria ◽  
Task Force ◽  
National Institutes Of Health ◽  
Pharmaceutical Companies ◽  
Working Definition ◽  
Age Related ◽  
Increased Risk ◽  
Definition Of

In May 2012, a Sarcopenia Consensus Summit was convened by the Foundation of the National Institutes of Health (FNIH), National Institute of Aging (NIA), and the U.S. Food and Drug Administration (FDA); and co-sponsored by five pharmaceutical companies. At this summit, sarcopenia experts from around the world worked to develop agreement on a working definition of sarcopenia, building on the work of previous efforts to generate a consensus. With the ultimate goal of improving function and independence in individuals with sarcopenia, the Task Force focused its attention on people at greatly increased risk of muscle atrophy as a consequence of hip fracture. The rationale for looking at this population is that since hip fracture is a recognized condition, there is a clear regulatory path forward for developing interventions. Moreover, patients with hip fracture may provide an appropriate population to advance understanding of sarcopenia, for example helping to define diagnostic criteria, develop biomarkers, understand the mechanisms that underlie the age-related loss of muscle mass and strength, and identify endpoints for clinical trials that are reliable, objective, and clinically meaningful. Task Force members agreed that progress in treating sarcopenia will require strengthening of partnerships between academia, industry, and government agencies, and across continents to reach consensus on diagnostic criteria, optimization of clinical trials design, and identification of improved treatment and preventive strategies. In this report, the main results of the Task Force discussion are presented.

scholarly journals COMPARING THE EFFECT OF SECOND-GENERATION ANTIPSYCHOTICS VERSUS SELECTIVE SEROTONIN REUPTAKE INHIBITORS IN REFRACTORY OBSESSIVE-COMPULSIVE DISORDER: A SYSTEMATIC REVIEW OF THE PAST, PRESENT, AND FUTURE CLINICAL TRIALS

2016 ◽  
Vol 10 (1) ◽  
pp. 150
Author(s):  
Mehdi Sayah ◽  
Fakher Rahim
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Early Treatment ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Second Generation ◽  
Treatment Programs ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Second Generation Antipsychotics

ABSTRACTObjective: In this concise and systematic review, the trend of using major medication modalities prescribed for refractory obsessive-compulsivedisorder (OCD), including serotonin-specific reuptake inhibitors (SSRIs) and second-generation antipsychotics (SGAs) are discussed.Methods: We systematically searched PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) systematically using Mesh terms. OCDis extremely disabling and associated with considerable depression and other serious psychiatric illnesses.Results: Through databases, we found 78 randomized clinical trials (RCTs), which included selective SSRI compared with routine drug therapy orplacebo. Out of these 78 studies, 62 studies were conducted on adult patients with OCD, comprising 7920 cases. While only 16 RCTs were performedon children and adolescents with OCD, including 1313 people. We found 24 clinical trial studies related to SGAs, of which were conducted on adultpatients with OCD, including 992 cases.Conclusion: As our data showed among the SSRIs, fluvoxamine has been particularly well studied and used in RCTs in both children and adolescents withOCD. According to the summary of our review, it will be better when therapists use SGAs in the early treatment programs of refractory OCD. Thus, consideringour reviewed, it seems that the first choice of early treatment programs of refractory OCD is fluvoxamine in combination with quetiapine or aripiprazole.Keywords: Obsessive-compulsive disorder, Refractory, Second-generation antipsychotic drugs, Selective serotonin reuptake inhibitors. 

Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment

2019 ◽  
Vol 33 (11) ◽  
pp. 1340-1351 ◽  
Author(s):  
Laiana A Quagliato ◽  
Fiammetta Cosci ◽  
Richard I Shader ◽  
Edward K Silberman ◽  
Vladan Starcevic ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Risk Factor ◽  
Panic Disorder ◽  
Adverse Effects ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Meta Analysis ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Short Term

Background:Benzodiazepines (BZs) and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacologic treatment of panic disorder (PD). However, treatment guidelines favor SSRIs over BZs based on the belief that BZs are associated with more adverse effects than SSRIs. This belief, however, is currently supported only by opinion and anecdotes.Aim:The aim of this review and meta-analysis was to determine if there truly is evidence that BZs cause more adverse effects than SSRIs in acute PD treatment.Methods:We systematically searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and clinical trials register databases. Short randomized clinical trials of a minimum of four weeks and a maximum of 12 weeks that studied SSRIs or BZs compared to placebo in acute PD treatment were included in a meta-analysis. The primary outcome was all-cause adverse event rate in participants who received SSRIs, BZs, or placebo.Results:Overall, the meta-analysis showed that SSRIs cause more adverse events than BZs in short-term PD treatment. Specifically, SSRI treatment was a risk factor for diaphoresis, fatigue, nausea, diarrhea, and insomnia, whereas BZ treatment was a risk factor for memory problems, constipation, and dry mouth. Both classes of drugs were associated with somnolence. SSRIs were associated with abnormal ejaculation, while BZs were associated with libido reduction. BZs were protective against tachycardia, diaphoresis, fatigue, and insomnia.Conclusion:Randomized, blinded studies comparing SSRIs and BZs for the short-term treatment of PD should be performed. Clinical guidelines based on incontrovertible evidence are needed.

Abstract WP402: Risks and Benefits of Selective Serotonin Reuptake Inhibitor Use Among Survivors of Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Patryk P Kubiszewski ◽  
Christina Kourkoulis ◽  
Zora DiPucchio ◽  
Kristin Schwab ◽  
Mahmut E Gurol ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Intracerebral Hemorrhage ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Recurrence Risk ◽  
Selective Serotonin ◽  
Prior History ◽  
Depression Severity ◽  
Risks And Benefits ◽  
Race Ethnicity

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are widely used to treat post-stroke depression, but they increase Intracerebral Hemorrhage (ICH) incidence in the general population. ICH survivors must therefore balance ICH recurrence risk with depression treatment benefits when considering SSRI use. We sought to determine risks and benefits of SSRI use among survivors of primary ICH. Hypothesis: SSRI exposure following ICH is associated with increased recurrent ICH risk and decreased depression severity. Methods: We analyzed data from the MGH-ICH study. We collected baseline patient information (demographics, race/ethnicity, medical history), ICH characteristics (location, size, associated functional impairment) and determined genetic (APOE e2/e4) and MRI markers of underlying small vessel disease. Participants were followed by phone and EMR review to determine: 1) recurrent ICH events; 2) onset and severity of depression (using the GDS-4 scale). We conducted univariable and multivariable analyses for ICH recurrence risk and depression severity as a function of SSRI exposure. We conducted a subset analysis for patients with one or more of the following characteristics associated high ICH recurrence risk: 1) probable or possible CAA diagnosis (Boston criteria); 2) presence of APOE e2/e4 gene variants; 3) prior history of ICH/TIA/ischemic stroke; 4) black or Hispanic race/ethnicity. Results: We enrolled and followed longitudinally 1010 ICH survivors. SSRI exposure was associated with both ICH recurrence (HR 1.22, 95% CI 1.06 - 1.40) and improvement of depressive symptoms (OR 0.73 for increase in GDS-4 score quartiles, 95% CI 0.59 - 0.90). Among individuals at high ICH recurrence risk SSRI use was associated with higher risk for ICH recurrence compared to all other ICH survivors (interaction p = 0.012). SSRI effect on depressive symptoms did not differ between high ICH recurrence risk individuals and all other participants. Conclusions: SSRI exposure is associated with both improvement in depressive symptoms after ICH and with increased hemorrhage recurrence risk. Clinical history, neuroimaging data and genetic biomarkers may represent viable tools to identify ICH survivors more likely to safely tolerate SSRI use.

Problemi di psicoterapia

2009 ◽  
pp. 45-56
Author(s):  
Paolo Migone
Keyword(s):  
Clinical Trials ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Randomized Clinical Trials ◽  
Interpersonal Relationship ◽  
Depression Scale ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Hamilton Depression Scale ◽  
Significant Difference

- Kirsch et al. (2002) studied all 47 randomized clinical trials (RCT) submitted by pharmaceutical companies to the U.S. Food and Drug Administration (FDA) for approval of the six most prescribed Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants. The mean difference between drug and placebo was less than 2 points on the 21-item (62- point) Hamilton Depression Scale (which is the version used in many of the these RTCs). This superiority to placebo, although statistically significant, was not clinically significant. Furthermore, 57% of the trials funded by the pharmaceutical industry failed to show a significant difference between drug and placebo. Most of these negative data were not published and were accessible only thanks to the Freedom of Information Act. Also other studies confirming this research (Whittington et al., 2004; Moncrieff & Hardy, 2007; Turner et al., 2008) are presented. These data are discussed in light of the wider problem of the roles of interpersonal relationship in psychiatric practice.KEY WORDS: antidepressants drugs, Selective Serotonin Reuptake Inhibitors (SSRI), placebo, Kirsch, Randomized Clinical Trials (RCT)]

Meta-Analysis of Controlled Pharmacologic Trials

1997 ◽  
Vol 8 (S3) ◽  
pp. 375-379 ◽  
Author(s):  
Lon S. Schneider
Keyword(s):  
Valproic Acid ◽  
Clinical Trials ◽  
Elderly Patients ◽  
Psychotropic Drugs ◽  
Meta Analysis ◽  
Behavioral Symptoms ◽  
Relative Efficacy ◽  
Behavioral Disturbances ◽  
Drug Classes ◽  
Adrenergic Blockers

Both pharmacologic and nonpharmacologic methods can be used to treat behavioral disturbances of dementia. Many drugs and drug classes have been advocated as having putative efficacy in treating nonspecific behavioral symptoms; the list includes neuroleptics, anxiolytics, antidepressants (e.g., trazodone), anticonvulsants (e.g., carbamazepine and valproic acid), lithium, β-adrenergic blockers, selegiline, and buspirone. Neuroleptics are among the most commonly prescribed psychotropic drugs for behavioral symptoms and have been described as being “modestly effective” in controlling agitation, both in patients with dementia and in elderly patients in general. To examine the relative efficacy of neuroleptics in treating behavioral disturbances of dementia, the author and colleagues performed a meta-analysis of clinical trials published in the literature from 1954 to 1989.

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