If a child is diagnosed with strep throat, few parents would hesitate to give them antibiotics prescribed by their doctor.
Decisions about taking medicine for mental health are not as easy.
“The most common mental health problems we see in children are ADHD, anxiety and depression,” says UNC Health pediatrician Rebecca Baum, MD, who specializes in developmental behavioral pediatrics.
Treatment for these common problems may include medication, she says.
After a diagnosis of attention deficit hyperactivity disorder, medication is often recommended as part of a comprehensive treatment plan. For depression and anxiety, treatment usually begins with counseling and other nonmedication options, and medicines are added as needed.
To help parents understand the medicines their children might be prescribed, we spoke with UNC Health pharmacist Amy Donnelly, PharmD.
Common Medicines for Depression and Anxiety
Most medicines given to children for depression, anxiety or obsessive-compulsive disorder fall into one of two categories, Donnelly says.
The first is selective serotonin reuptake inhibitors, or SSRIs. Serotonin is one of the chemical messengers that carries signals between nerve cells in the brain. SSRIs increase the amount of serotonin in the brain by blocking it from being reabsorbed into the nerve cells. Examples of these medicines include Prozac (fluoxetine), Zoloft (sertraline) and Lexapro (escitalopram).
Serotonin and norepinephrine reuptake inhibitors, or SNRIs, keep more serotonin and norepinephrine (another brain chemical that helps carry messages across brain nerve cells) in the brain. Having more serotonin and norepinephrine available means that information can be transmitted easier from one nerve to another. This class of medicine includes Cymbalta (duloxetine) and Effexor (venlafaxine).
Both SSRIs and SNRIs can help regulate mood, emotion and sleep, Donnelly says.
“They really can improve someone’s quality of life, especially if the condition has taken over their daily functioning,” she says. “In most cases, the benefits outweigh the risks.”
And there are risks that parents should look out for when their child is taking these medications.
The main side effects are headaches, weight gain or loss, and gastrointestinal issues such as nausea and diarrhea, Donnelly says.
Although it’s rare, parents also should watch for suicidal thoughts or behaviors, especially during the first few weeks after starting the medicine or after the dosage is changed. Depression and anxiety can also cause these thoughts and behaviors.
“I always make sure parents know about these risks,” Donnelly says. “They can ask their child to tell them how they are feeling—happier, sadder, just not like themselves. Let them know their doctor can make changes if they don’t like the way they are feeling.”
Don’t expect big changes right away. “We tell patients that it usually takes six to eight weeks before you get the maximum benefits,” she says.
If a medicine is helping, the child may need to continue taking it until they have been stable for six to 12 months, Donnelly says.
And never stop taking these medicines suddenly. “You need to get off slowly by lowering the dose over time,” Donnelly says. “Your doctor is the one who will know best when and how to change medicines or doses.”
Common Medicines for ADHD
Stimulant medications are most commonly used to treat ADHD, Donnelly says. These are controlled substances; it’s illegal to share them with others, and they should be used only as prescribed.
Some nonstimulant treatments are also available to treat ADHD. These are used primarily for children who do not tolerate stimulants well.
Many of these medicines are available in a variety of forms, including tablets, capsules, liquids and dissolvable formulations. Doses will be carefully calculated for each patient, Donnelly says.
Common medicines to treat ADHD include Ritalin (methylphenidate), Concerta (methylphenidate), Adderall (mixed amphetamine salts) and Vyvanse (lisdexamfetamine), but many others are available.
“It seems puzzling that stimulants are used to treat a hyperactivity disorder,” Donnelly says, “but usually the stimulation helps them focus.”
Most of these medicines prevent brain cells from reabsorbing the brain chemicals dopamine and norepinephrine. Dopamine is a chemical that helps messages pass between nerve cells. It plays a role in how we feel pleasure and is a big part of how we can think and plan.
Side effects of ADHD medicines include a loss of appetite and trouble falling asleep. Other side effects depend on the type of medication. Your child’s doctor or pharmacist can give you more information.
Make a Plan for Communication
Choosing who to talk with about your child’s mental health is important.
“Having open communication with your child is important, and we also recommend involving your child’s doctor, too, so they can help,” Dr. Baum says. “When prescribing medication, I always encourage my patients to tell me if they don’t like the way the medicine makes them feel. That way we can change something if we need to.”
Parents may wish to talk with their child’s teachers, coaches and other adults who are with the child during the day, but that’s also a personal decision for each child and their family.
For example, sharing a diagnosis of ADHD with the child’s teacher may help the teacher be better able to support the child in the classroom setting.
If you have questions about any medicine your child is taking, talk to your pharmacist or doctor. If you need a doctor, find one near you.