Medications for Childhood PTSD: It’s All Off-Label

Topics: Child Psychiatry | Practice Tools and Tips | Psychopharmacology Tips | PTSD

In 2011, we wrote a review of medications for PTSD in children and found, unfortunately, that data to inform true evidence-based practice was scant. There are still no psychotropic medications that have been proven effective in randomized controlled trials for children with PTSD and there are no FDA approved medications for this population. Nonethele

Trauma Systems Therapy

Topics: Antidepressants | Anxiety Disorder | Child Psychiatry | Practice Tools and Tips | Psychopharmacology Tips | Psychotherapy | PTSD

Informed Consent in Opioid Addiction Treatment: An Ethical Obligation

Topics: Addiction | Free Articles | Psychopharmacology Tips

Informed consent—whether it be for psychotherapy, prescribing a medication, or performing a surgical procedure—is an ethical principle firmly established in law and medicine. While there has been no formal research on this subject, my experience suggests that many addiction treatment programs fail to obtain valid informed consent. The starkest ex

Dealing With Side Effects of SSRIs

Topics: Antidepressants | Antipsychotics | Child Psychiatry | Psychopharmacology Tips

Selective serotonin reuptake inhibitors (SSRIs) are widely used as the first-line treatment for depression and anxiety in children and adolescents, but they are associated with significant adverse effects (AEs). Studies have shown that up to 50% of kids experience side effects from SSRIs, depending on the sample size and the type of study. The most c

Metabolic and Extrapyramidal Effects of Antipsychotics

Topics: Antidepressants | Antipsychotics | Child Psychiatry | Psychopharmacology Tips

Table 1: Risks of Side Effects of Antipsychotics in Children and Adolescents Click here to open pdf

Vivitrol: Another Option for Opioid Addiction?

Topics: Addiction | Psychopharmacology Tips

Naltrexone first hit the US market as an oral medication (ReVia) way back in 1984. Over the years, it developed a solid reputation for treating alcoholism and remains a first-line therapy today. Naltrexone was a bust, however, when it came to treating opioid addiction. Oral naltrexone has been found to be no better than placebo at achieving abstinenc

Methadone versus Buprenorphine

Topics: Addiction | Psychopharmacology Tips

The Facts on Tardive Dyskinesia

Topics: Psychopharmacology Tips

We’re all aware that neuroleptics and other dopamine-receptor blocking agents (DRBAs) can cause a variety of movement disorders, often referred to as extrapyramidal syndromes (EPS). Many EPS, such as acute dystonia, akathisia, or drug-induced parkinsonism, typically manifest within hours or days (sometimes a few weeks) after patients start neurolep

Medication Non-Adherence: The Make-It-or-Break-It of Psychopharmacology

Topics: Child Psychiatry | Psychopharmacology Tips

Both in general medicine and in psychiatry, the number one cause of treatment failure is not taking medications as prescribed. There are a number of reasons for non-adherence, ranging from physical side effects to psychological issues. Here, we’ll discuss the most common reasons for non-adherence, and some strategies for helping your patients stay on

Managing Side Effects of Psychotropics

Topics: Child Psychiatry | Psychopharmacology Tips

We all know that medication use for psychiatric disorders in kids has been increasing over the past 10 years, and that it plays an important role in treatment. We also know that side effects can cause alarm among parents and young patients. In the name of providing the best treatment (ie, making sure patients take their medication), psychiatrists may

Drug Interactions in Child Psychiatry

Topics: Child Psychiatry | Psychopharmacology Tips

Drug interactions are a common issue in psychopharmacology. The advent of drug interaction software has made it easier to keep track of drug interactions, but it is still important to have a sound understanding of the principles in order to apply the results of drug interaction software alerts to daily patient care. This is true for several reasons:

Safe Prescribing of Meds for ADHD

Topics: Child Psychiatry | Psychopharmacology Tips

Managing the Risk of Prescription Drug Abuse

Topics: Psychopharmacology Tips

We’ve all been taught not to prescribe addictive drugs to patients who will abuse them, but in the real world it is not always easy to tell who those patients are or to manage the resulting problems. The stakes are high: unintentional overdoses of prescription medication account for 27,000 deaths in the United States each year, more than heroin and co

Managing the Risk of Prescription Drug Abuse

Topics: Free Articles | Psychopharmacology Tips

Drug Interactions in Psychiatry: A Practical Review

Topics: Psychopharmacology Tips

During the heyday of the SSRI wars, every pharmaceutical sales rep was educating us about drug interactions. Zoloft and Celexa reps would gloat about how “clean” their drugs were, while Paxil reps would try to shift the conversation to a discussion of social anxiety disorder. Now that most SSRIs have gone generic, the reps have stopped pushing them,

How to Discuss Medications with Parents

Topics: Child Psychiatry | Free Articles | Psychopharmacology Tips

Combining Meds for Depression: The State of The Art

Topics: Psychopharmacology Tips

In surveys, it’s clear that most psychiatrists practice as unimaginatively as I typically do, meaning that their drug of first choice for most depressed patients is an SSRI (Petersen T, et al., Prog Neuropsychopharmacol Biol Psychiatry 2002; 26:177-187). If SSRIs don’t work, there are various options. Optimization, or raising the dose, is one option

Dosing Psychotropics: How High Can We Go?

Topics: Psychopharmacology Tips

How high can we safely dose common psychotropics? Given the poor performance of medication combinations in recent studies, it’s time for a close look at the safety and efficacy of raising doses, sometimes known as “dose optimization.” Since there are few controlled studies of very high doses, we are likely to make plenty of inferential errors w