Prescribing psychotropic medications to adolescents
Dr Neeraj Sareen, Consultant Psychiatrist, The Melbourne Psychiatry Centre
Prescribing psychotropic medications to adolescents is a complex process that should be guided by several principles to ensure the safety and effectiveness of the treatment?(NPS, 2023).
As a prescriber this is the most challenging scenario with varying degrees of expectations from the young person, their parents/guardians, and their age vs maturity to consent for taking the medication. There is no one size fits all approach, and this decision generally involves a comprehensive dialogue between all involved.
I have come across case examples whereby the adolescent is not keen to consider any pharmacological treatment while their parents/school network is advocating for it and vice-a-versa.
In few other clinical situations, young adults in their 20s have reflected on how their efforts to seek help as teenager were disregarded due to parental concerns about their child being medicated. Regardless, there have been publications across the world (US, UK, and Europe) around trends of increased psychotropic medication prescriptions in children, which includes antidepressants, antipsychotics, or stimulant medications?(Maja R Radoj?i?, 2023).
There are several concerns around using psychotropic medications in adolescents, including:
Safety
There is a concern that psychotropic medications can cause serious side effects, particularly in developing adolescents. Some medications can increase the risk of suicidal thoughts, agitation, and aggression, and can also have long-term effects on brain development. Their developing brains react differently to medications, and they are likely to experience different side effects due to differences in metabolism.
Misuse and Overuse
There is a concern that psychotropic medications may be over prescribed or misused, particularly for off-label use or for conditions that may not require medication. This can lead to unnecessary exposure to potential side effects and long-term health risks.
Stigma
There is a concern that psychotropic medications may contribute to the stigmatisation of mental health issues, particularly if medication is seen as the only solution. This can discourage adolescents from seeking other forms of treatment or support.
Lack of Long-term Studies
There is a concern that the long-term effects of psychotropic medications on adolescent brain development and overall health are not well understood. Long-term studies are needed to assess the potential risks and benefits of these medications. This can be quite difficult due to lack of funding, high costs, difficulties in recruitment, long time frames needed for assessing impacts/side effects and ethical concerns around conducting research in this age group.
Limited Treatment Options
There is a concern that psychotropic medications may be used as a first-line treatment, rather than as part of a comprehensive treatment plan that includes therapy and other non-pharmacological interventions. This can limit treatment options for adolescents and may not address the underlying causes of their mental health issues.
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Understandably, there are concerns that this trend is not necessarily indicative of improved health outcomes.?(Aswin Ratheesh, 2023).
Some of the principles of prescribing psychotropic medications to adolescents are:
Thorough Evaluation
Before prescribing any medication, a thorough evaluation of the adolescent's mental and physical health should be conducted, including a review of their medical history, psychiatric history, and current symptoms. The evaluation should also assess the adolescent's family history, social environment, and any other factors that may impact their mental health.
Evidence-Based Approach
The prescribing of psychotropic medications should be based on evidence-based practices, including the use of medications that have been shown to be effective in treating the adolescent's specific mental health condition. If a medication is being considered off-label, an open discussion on rationale, pros and cons of medication and alternative options.
Individualized Treatment Plan
The treatment plan should be individualized to the specific needs of the adolescent and should consider their unique circumstances, including their age, weight, medical history, and other medications they may be taking.
Informed Consent
Adolescents and their parents or guardians should be fully informed of the risks and benefits of the medication, as well as any potential side effects or adverse reactions. Informed consent should be obtained from the adolescent and their parents or guardians before starting treatment.
Monitoring and Follow-Up
Regular monitoring of the adolescent's mental and physical health, as well as their response to the medication, is important to ensure the safety and effectiveness of the treatment. Follow-up appointments should be scheduled to assess the ongoing need for medication and to adjust the treatment plan as needed.
?Multidisciplinary Collaboration
Prescribing psychotropic medications to adolescents should be a collaborative effort that involves input from a range of healthcare professionals, including psychiatrists, paediatricians, and other allied health professionals.
Continuous Education
Healthcare professionals prescribing psychotropic medications to adolescents should engage in continuous education to stay up to date with the latest research and guidelines related to the use of these medications in this population.
Overall, the use of psychotropic medications in adolescents should be carefully considered and individualized to the specific needs of each patient. Close monitoring, collaboration between healthcare professionals, and informed consent are essential to ensure the safety and effectiveness of these treatments.?
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