Behavioural and emotional disorders in childhood: A brief overview for paediatricians

Table 8 Major classes of medications used in management of childhood emotional and behavioural disorders

	Common examples	Indications for use	Common Side-effects	Follow up monitoring
Traditional antipsychotics	Haloperidol, Chlorpromazine, Thiotixene, Perphenazine, Trifluoperazine	Schizophrenia, Bipolar disorder, Schizoaffective, Disorder, Obsessive-compulsive disorder, Depression, Aggression, Mood instability, Irritability in ASD	Tremors, Muscle spasms, Abnormal movements, Stiffness, Blurred vision, Constipation	Frequent blood tests (Clozapine), Blood pressure checks, Cholesterol testing, Heart Rate checks, Blood Sugar testing, Electrocardiogram, Height, Weight and blood chemistry tests
Atypical antipsychotics	Aripiprazole, Clozapine, Olanzapine, Quetiapine, Risperidone, Ziprasidone		Low white blood cell count (Agranulocytosis - with Clozapine), Diabetes, Lipid abnormalities, Weight gain, Other medication-specific side effects
Tricyclic antidepressants	Amytriptyline, Desipramine, Doxepin, Imipramine, Nortriptyline,	Depression, Anxiety, Seasonal Affective Disorder, OCD, Posttraumatic Stress Disorder, Social Anxiety, Bed-wetting and pre-menstrual syndrome	Dry mouth, Constipation, Blurry vision, Urinary retention, Dizziness, Drowsiness	Watch for worsening of depression and thoughts about suicide, Watch for unusual bruises, bleeding from the gums when brushing teeth, especially if taking other medications, Blood tests and Blood pressure checks may be needed
Selective Serotonin Reuptake Inhibitors	Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Sertraline		Headache, Nervousness, Nausea Insomnia, Weight Loss
Serotonin-norepinephrine reuptake inhibitor	Venlafaxine, Levomilnacipran, Duloxetine, Desvenlafaxine
Other antidepressants	Bupropion, Mirtazepine, Trazodone
Stimulants	Methylphenidate Immediate Release and Modified Release (e.g., Concerta XL, Equasym XL), Dexamfetamines Immediate Release and Modified Release (e.g., Lisdexamfetamine)	ADHD	Decreased appetite/ weight loss, Sleep problems, Jitteriness, restless, Headaches, Dry mouth, Dysphoria, feeling sad, Anxiety, Increased heart rate, Dizziness	Blood pressure and heart rate will be checked before treatment and periodically during treatment. Child’s height and weight are monitored
Non-stimulants	Atomoxetine
Alpha-2 agonists	Clonidine, Guanfacine		Drowsiness, Dizziness, Sleepiness
Benzodiazepines	Lorazepam, Clonazepam, Diazepam, Alprazolam, Oxazepam, Chlordiazepoxide	Anxiety, Panic disorder, Alcohol withdrawal, PTSD, OCD	Drowsiness, Dizziness, Sleepiness, Confusion, Memory loss, Blurry vision, Balance problems, Worsening behaviour	Do not stop these medications suddenly without slowly reducing (tapering) the dose as directed by the clinician. While taking buspirone, avoid grapefruit juice, Avoid alcohol, Blood tests may be needed prior to the start of treatment and during treatment
Antihistamines	Hydroxyzine HCl, Hydroxyzine, Pamoate, Alimemazine		Sleepiness, Drowsiness, Dizziness, Dry mouth, Confusion, Blurred Vision, Balance problems, Heartburn
Other anxiolytics	Buspirone		Dizziness, Nausea, Headache, Lightheadedness, Nervousness
Sleep-enhancement	Zolpidem, Zaleplon, Diphenhydramine, Trazodone	Insomnia (short-term)	Headache, Dizziness, Weakness, Nausea, Memory loss, Daytime sleepiness, Hallucinations, Dry mouth, Confusion, Blurred Vision, Balance problems, Heartburn	Blood tests may be needed before the start of treatment. Avoid alcohol

Modified from “Medications used for behavioral and emotional disorders. A guide for parents, foster parents, families, youth, caregivers, guardians, and social workers.” May 2010. Available Online: URL: http://www.ct.gov/dcf/lib/dcf/ccmu/pdf/cmcu_-_educational_booklet_5-7-2010.pdf. ADHD: Attention deficit hyperactivity disorder; ASD: Autistic spectrum disorder; PTSD: Post traumatic stress disorder; OCD: Obsessive-compulsive disorder.