Child Psychology and Psychiatry

Approaches to intervention
Table 46.3
Specific side effects of selected psychotropic medication.
Drug
Precautions
Side effects
Non-stimulant
Atomoxetine
(noradrenaline reuptake
inhibitor)
Contraindicated in
hepatic impairment,
glaucoma, uncontrolled
seizures, or a history of
hypersensitivity to drug;
use with caution in
hypertension,
tachycardia,
cardiovascular problems,
and patients with long
QT interval or family
history of QT
prolongation, or
cerebrovascular disease
Growth retardation:
reduction of two to
three percentiles in mean height, and
some weight loss
Seizure liability:
not to be used in patients
with uncontrolled seizures, and should be
discontinued in those who develop or have
an increased frequency of seizures
Cardiovascular:
increases heart rate (by
increasing noradrenergic tone) and small
increase in blood pressure; QT interval
prolongation
Suicide risk:
monitor for signs of
depression, suicidal thoughts and
behaviour
∗
Liver dysfunction:
severe liver
injury—rare. Abnormal liver enzymes are
more common. Discontinue on first
symptom or sign of liver dysfunction, e.g.
pruritus, dark urine, jaundice, right upper
quadrant tenderness or unexplained
flu-like symptoms
Tricyclic antidepressants
Imipramine, amitriptyline,
nortriptyline,
desipramine,
clomipramine
Use has declined due to
concerns of cardiac
arrhythmias and case
reports of sudden death
Cardiotoxicity, danger of accidental or
intentional overdose, troublesome
sedation, anticholinergic side effects,
lowered seizure threshold
Newer antidepressants
SSRIS
: fluoxetine,
fluvoxamine, sertraline,
paroxetine, citalopram,
escitalopram
SNRI:
venlafaxine
NRI:
reboxetine,
mirtazapine
It is currently advised
that children or
adolescents being
started on, or dose being
increased of,
antidepressants should
be monitored closely for
emergence or worsening
of suicidal ideation or
behaviour
Antidepressant-related suicidal ideation
and behaviour:
consistently there has been
increased suicidal ideation with use of
antidepressants in childhood depression.
This has to be balanced with genuine
suicidal risk in untreated severe
depression
†
Antidepressant-induced behavioural
activation:
increased motor activity,
restlessness, excitability and impulsivity
that occurs usually early in treatment and
may be reduced by using the MED
principle; managed by reducing the dose,
and with a benzodiazepine for a few days
(
continued overleaf
)