Antidepressants and antipsychotics in children
A Child & Adolescent Psychiatrist at Northumberland, Tyne & Wear Mental Health Trust (NTW) has received a number of queries from community pharmacies regarding prescriptions of antidepressants and antipsychotics in children.
Dr Ruppa Geethanath has therefore kindly produced a document which will hopefully support community pharmacists, details shown below.
Of course, we still encourage any pharmacist to double check any prescriptions where they have significant concerns however it is hoped the information below will be supportive.
Guide for community pharmacists: Use of SSRIs and antipsychotics in South of Tyne CYPS (Children and Young Peoples Services)
Use of SSRIs in CYPS
As a group of Child and Adolescent Psychiatrists we are aware that Fluoxetine is the only SSRI licensed for use as an antidepressant in children.
This is our first choice of antidepressant for moderate-severe depression in children when talking therapies alone haven’t been effective, as per NICE guidelines.
As per NICE guidelines we start with 10 mg and increase to 20 mg. We use higher doses for persistent depression when 20 mg hasn’t been fully effective, as per NICE guidelines (we are aware that this is unlicensed use, and discuss this with child and family).
When fluoxetine hasn’t been effective for moderate-severe depression alongside talking therapies we use Sertraline or Citalopram as per NICE guidelines (we are aware that this is an unlicensed use, and discuss this with child and family).
- With sertraline we start with 25 mg od and gradually increase as necessary to a maximum of 200 mg od.
- With citalopram we start with 10 mg and increase to a maximum of 30 mg od.
We are aware that sertraline is licensed for use in OCD in children and we do use sertraline at the above doses for OCD and for anxiety disorders of moderate-severe nature that hasn’t responded to CBT (cognitive behavioural therapy) alone.
Use of antipsychotics in CYPS
We are aware that Risperidone is the only licensed antipsychotic for treatment of severe aggression in children with conduct problems.
However other antipsychotics with a better side effect profile are licensed for use in mania and schizophrenia eg Aripiprazole.
Therefore either antipsychotic is used when necessary for treatment of psychoses or mania or extreme aggression.
Olanzapine or Quetiapine are also used for treatment of mania or psychoses when more sedative/ calming effect is required, this is indicated use as per BNF. (We are aware that this is an unlicensed use, and discuss this with child and family).
Dr Uma Ruppa Geethanath, Consultant Child and Adolescent Psychiatrist, NTW