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Mental Disorders and Psychiatric Medications (page 6)

— National Institute of Mental Health
Updated on Jul 26, 2007

Children's Medication Chart

TRADE NAME GENERIC NAME APPROVED AGE
Stimulant Medications
Adderall amphetamine 3 and older
Adderall XR amphetamine
(extended release)
6 and older
Concerta methylphenidate
(long acting)
6 and older
Cylert* pemoline 6 and older
Dexedrine dextroamphetamine 3 and older
Dextrostat dextroamphetamine 3 and older
Focalin dexmethylphenidate 6 and older
Metadate ER methylphenidate
(extended release)
6 and older
Ritalin methylphenidate 6 and older
Non-stimulant for ADHD
Strattera atomoxetine 6 and older
*Because of its potential for serious side effects affecting the liver, Cylert should not ordinarily be considered as first-line drug therapy for ADHD.
Antidepressant and Antianxiety Medications
Anafranil clomipramine 10 and older (for OCD)
BuSpar buspirone 18 and older
Effexor venlafaxine 18 and older
Luvox (SSRI) fluvoxamine 8 and older (for OCD)
Paxil (SSRI) paroxetine 18 and older
Prozac (SSRI) fluoxetine 18 and older
Serzone (SSRI) nefazodone 18 and older
Sinequan doxepin 12 and older
Tofranil imipramine 6 and older (for bedwetting)
Wellbutrin bupropion 18 and older
Zoloft (SSRI) sertraline 6 and older (for OCD)
Antipsychotic Medications
Clozaril (atypical) clozapine 18 and older
Haldol haloperidol 3 and older
Risperdal (atypical) risperidone 18 and older
Seroquel (atypical) quetiapine 18 and older
Mellaril thioridazine 2 and older
Zyprexa (atypical) olanzapine 18 and older
Orap pimozide 12 and older (for Tourette's syndrome—Data for age 2 and older indicate similar safety profile)
Mood Stabilizing Medications
Cibalith-S lithium citrate 12 and older
Depakote valproic acid 2 and older (for seizures)
Eskalith lithium carbonate 12 and older
Lithobid lithium carbonate 12 and older
Tegretol carbamazepine any age (for seizures)

Addendum to Medications Booklet January 2007

This addendum to the booklet Medications for Mental Illness (2005) was prepared to provide updated information on medications in the booklet and results of recent research on medications. This addendum also applies to the Medications Web page document.

Updates

Antidepressant Medications

Nefazodone/brand name Serzone: The manufacturer discontinued sales of the antidepressant in the U.S. effective June 14, 2004.

FDA Warnings and Antidepressant Medications

Despite the relative safety and popularity of SSRIs and other antidepressants, some studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. In 2004, after a thorough review of data, the Food and Drug Administration (FDA) adopted a "black box" warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the agency extended the warning to include young adults up to age 25. A "black box" warning is the most serious type of warning on prescription drug labeling. The warning emphasizes that children, adolescents and young adults taking antidepressants should be closely monitored, especially during the initial weeks of treatment, for any worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. See list of antidepressants medications at the end of this Addendum.

Antipsychotic Medications

Below are further details concerning side effects of antipsychotic medications found on pages 5 and 6 in the original Medications for Mental Illness booklet. The medications discussed below are primarily used to treat schizophrenia or other psychotic disorders.

The typical (conventional) antipsychotic medications include chlorpromazine (Thorazine®), haloperidol (Haldol®), perphenazine (Etrafon, Trilafon®), and fluphenzine (Prolixin®). The typical medications can cause extrapyramidal side effects, such as rigidity, persistent muscle spasms, tremors, and restlessness.

In the 1990s, atypical (second generation) antipsychotics were developed that are less likely to produce these side effects. The first of these was clozapine (Clozaril®, Prolixin®), introduced in 1990. It treats psychotic symptoms effectively even in people who do not respond to other medications. However, it can produce a serious but rare problem called agranulocytosis, a loss of the white blood cells that fight infection. Therefore, patients who take clozapine must have their white blood cell counts monitored every week or two. The inconvenience and cost of both the blood tests and the medication itself has made treatment with clozapine difficult for many people, but it is the drug of choice for those whose symptoms do not respond to other typical and atypical antipsychotic medications.

After clozapine was introduced, other atypical antipsychotics were developed, such as risperidone (Risperdal®), olanzapine (Zyprexa®), quietiapine (Seroquel®) and ziprasidone (Geodon®). The newest atypicals include aripiprazole (Abilify®) and paliperidone (Invega®). All are effective and are less likely to produce extrapyramidal symptoms or agranulocytosis. However, they can cause weight gain, which may result in an increased risk of diabetes and high cholesterol level.1,2

The FDA has determined that the treatment of behavioral disorders in elderly patients with atypical (second generation) antipsychotic medications is associated with increased mortality. These medications are not approved by the FDA for the treatment of behavioral disorders in patients with dementia.

Children and Medications

In October 2006, the FDA approved risperidone (Risperdal®) for the symptomatic treatment of irritability in autistic children and adolescents ages 5 to 16. The approval is the first for the use of a drug to treat behaviors associated with autism in children. These behaviors are included under the general heading of irritability, and include aggression, deliberate self-injury and temper tantrums.

Fluoxetine (Prozac®) and sertraline (Zoloft®) are approved by the FDA for children age 7 and older with obsessive-compulsive disorder. Fluoxetine is also approved for children age 8 and older for the treatment of depression. Fluoxetine and sertraline are selective serotonin reuptake inhibitors (SSRIs). See above for the (FDA) warning concerning SSRIs and other antidepressants.

Research on Medications

In recent years, NIMH has conducted large scale clinical trials to identify effective treatments for schizophrenia, depression, and bipolar disorder. Researchers also wanted to determine the long- term success of different treatments and provide options for patients and clinicians that are based on sound research. The studies were held in many sites across the country to reflect the diversity of real world clinical settings. Details about these studies can be found by clicking on the links below. As additional information about the results of these studies becomes available, updates will be added to the NIMH Web site.

Clinical Antipsychotic Trials of Intervention Effectiveness Study (CATIE)

CATIE compared the effectiveness of typical antipsychotic medications (first available in the 1950s) and atypical antipsychotic medications (available since the 1990s) used to treat schizophrenia.

The main goal of STAR*D was to identify the best "next steps" for people with depression who need to try more than one treatment when the first does not work.

STEP-BD aimed to obtain long-term data on the chronic, recurrent course of bipolar disorder; identify the best treatments for those with the disorder; obtain data for predicting recurrence of a manic or depressive episode; and study whether adding any one of three medications improved the outcomes for patients with treatment-resistant bipolar disorder.

TADS compared the use of cognitive-behavioral therapy (CBT) alone, medication (fluoxetine) alone, or a combination of both treatments in adolescents with depression.

These studies provide answers to many, but not all questions about treatment options and help further the understanding of these disorders. NIMH will continue to investigate various approaches to understanding these and other disorders, as well as identify treatments that meet the individual needs of patients.

Antidepressant Medications

List of drugs receiving a "black box" warning, other product labeling changes, and a Medication Guide pertaining to pediatric suicidality:

  1. Anafranil (clomipramine)
  2. Asendin (amoxapine)
  3. Aventyl (nortriptyline)
  4. Celexa (citalopram hydrobromide)
  5. Cymbalta (duloxetine)
  6. Desyrel (trazodone HCl)
  7. Effexor (venlafaxine HCl)
  8. Elavil (amitriptyline)
  9. Etrafon (perphenazine/amitriptyline)
  10. fluvoxamine maleate
  11. Lexapro (escitalopram hydrobromide)
  12. Limbitrol (chlordiazepoxide/amitriptyline)
  13. Ludiomil (maprotiline)
  14. Marplan (isocarboxazid)
  15. Nardil (phenelzine sulfate)
  16. Norpramin (desipramine HCl)
  17. Pamelor (nortriptyline)
  18. Parnate (tranylcypromine sulfate)
  19. Paxil (paroxetine HCl)
  20. Pexeva (paroxetine mesylate)
  21. Prozac (fluoxetine HCl)
  22. Remeron (mirtazapine)
  23. Sarafem (fluoxetine HCl)
  24. Serzone (nefazodone HCl)
  25. Sinequan (doxepin)
  26. Surmontil (trimipramine)
  27. Symbyax (olanzapine/fluoxetine)
  28. Tofranil (imipramine)
  29. Tofranil-PM (imipramine pamoate)
  30. Triavil (perphenazine/amitriptyline)
  31. Vivactil (protriptyline)
  32. Wellbutrin (bupropion HCl)
  33. Zoloft (sertraline HCl)
  34. Zyban (bupropion HCl)

If you have questions regarding these guidelines and use of NIMH publications please contact the NIMH Information Center at 1-866-615-6464 or email at nimhinfo@nih.gov.

1Marder SR, Essock SM, Miller AL, et al. Physical Health Monitoring of Patients With Schizophrenia. Am J Psychiatry. August 2004;161(8):1334-1349.

2Newcomer JW. Clinical considerations in selecting and using atypical antipsychotics. CNS Spect. Aug 2005;10(8 Suppl 8):12-20.

References

1Fenton WS. Prevalence of spontaneous dyskinesia in schizophrenia. Journal of Clinical Psychiatry, 2000; 62 (suppl 4): 10-14.

2Bowden CL, Calabrese JR, McElroy SL, Gyulai L, Wassef A, Petty F, et al. For the Divalproex Maintenance Study Group. A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Archives of General Psychiatry, 2000; 57(5): 481-489.

3Vainionpää LK, Rättyä J, Knip M, Tapanainen JS, Pakarinen AJ, Lanning P, et al. Valproate-induced hyperandrogenism during pubertal maturation in girls with epilepsy. Annals of Neurology, 1999; 45(4): 444-450.

4Soames JC. Valproate treatment and the risk of hyperandrogenism and polycystic ovaries. Bipolar Disorder, 2000; 2(1): 37-41.

5Thase ME, and Sachs GS. Bipolar depression: Pharmacotherapy and related therapeutic strategies. Biological Psychiatry, 2000; 48(6): 558-572.

6Department of Health and Human Services. 1999. Mental Health: A Report of the Surgeon General. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institute of Mental Health.

7Altshuler LL, Cohen L, Szuba MP, Burt VK, Gitlin M, and Mintz J. Pharmacologic management of psychiatric illness during pregnancy: Dilemmas and guidelines. American Journal of Psychiatry, 1996; 153(5): 592-606.

8Physicians' Desk Reference, 54th edition. Montavale, NJ: Medical Economics Data Production Co. 2000.

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