Psychiatric Pharmacy Essentials: Child and Adolescent Psychiatry

Children and adolescents are not “miniature adults”. The safe and effective use of pharmacotherapy in pediatric populations requires attention to developmental changes, as well as an appreciation for the differential presentation of mental illnesses relative to adults.

Essential Questions and References

  • What do I need to know about developmental pharmacology?1-2
  • How might the disposition of psychotropic drug levels differ in pediatric populations?3
  • What is the effectiveness and safety of antipsychotics4-5 and antidepressants6-7 in pediatric populations?
  • What is the evidence for pharmacologic treatments for bipolar disorder in pediatric populations?8-9
  • What is the evidence for pharmacotherapy and/or cognitive behavioral therapy for managing obsessive compulsive disorder in pediatric populations?10-11
  • What is the evidence for combination pharmacotherapy and cognitive behavioral therapy for managing SSRI-resistant major depressive disorder in pediatric patients?12-13

Reviewer 1:  Claire Herbst, PharmD, BCPS, BCPP
Reviewer 2: Joseph M. Cusimano, PharmD, BCPP
Reviewer 3: Austin Smith, PharmD, BCPP
2023-2024 AAPP Resident and New Practitioner Committee

References

  1. Kearns GL, Abdel-Rahman SM, Alander SW, et al. Developmental pharmacology—drug disposition, action, and therapy in infants and children. N Engl J Med. 2003;349(12):1157-67. [PubMed]
  2. Mulla H. Understanding developmental pharmacodynamics: importance for drug development and clinical practice. Pediatr Drugs. 2010;12(4):223-33. [PubMed]
  3. Fekete S, Hiemke C, Gerlach M. Dose-related concentrations of neuroactive/psychoactive drugs expected in blood of children and adolescents. Ther Drug Monit. 2020;42(2):315-324. [PubMed]
  4. Pillay J, Boylan K, Carrey N, et al. First- and second-generation antipsychotics in children and young adults: systematic review update [Internet]. AHRQ Comparative Effectiveness Reviews. Report No.: 17-EHC001-EF. [PubMed]
  5. Pillay J, Boylan K, Newton A, et al. Harms of antipsychotics in children and young adults: a systematic review update. Can J Psychiatry. 2018;63(10):661-678. [PubMed]
  6. Hetrick SE, McKenzie JE, Bailey AP, et al. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021;5(5):CD013674. [PubMed]
  7. Zhou X, Teng T, Zhang Y, et al. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. Lancet Psychiatry. 2020;7(7):581-601. [PubMed]
  8. Liu H, Potter MP, Woodworth KY, et al. Pharmacologic treatments for pediatric bipolar disorder: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2011;50(8):749-62.e39. [PubMed]
  9. Yee CS, Hawken ER, Baldessarini RJ, Vázquez GH. Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses. Int J Neuropsychopharmacol. 2019;22(8):531-540. [PubMed]
  10. Ivarsson T, Skarphedinsson G, Kornør H, et al. The place of and evidence for serotonin reuptake inhibitors (SRIs) for obsessive compulsive disorder (OCD) in children and adolescents: Views based on a systematic review and meta-analysis. Psychiatry Res. 2015;227(1):93-103. [PubMed]
  11. Uhre CF, Uhre VF, Lønfeldt NN, et al. Systematic review and meta-analysis: cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2020;59(1):64-77. [PubMed]
  12. Brent D, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller M, 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;299(8):901-13. DOI: 10.1001/jama.299.8.901. PubMed PMID: 18314433; PubMed Central PMCID: PMC2277341.
  13. Vitiello B, Emslie G, Clarke G, et al. Long-term outcome of adolescent depression initially resistant to selective serotonin reuptake inhibitor treatment: a follow-up study of the TORDIA sample. J Clin Psychiatry. 2011;72(3):388-96. [PubMed]