Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned.
Below are a few special points to bear in mind:
Children — Studies consistently show that about 15 percent of the U.S. population below age 18, or more than 9 million children, suffer from a psychiatric disorder that compromises their ability to function. It is easy to overlook the seriousness of childhood mental disorders.
In children, these disorders may present symptoms that are different or less clearcut than the same disorders in adults. Younger children, especially, may not talk about what’s bothering them, but this is sometimes a problem with older children as well. For this reason, having a doctor, other mental health professional, or psychiatric team examine the child is especially important.
There is an array of treatments that can help these children. These include medications and psychotherapy, behavioral therapy, treatment of impaired social skills, parental and family therapy, and group therapy. The therapy used for an individual child is based on the child’s diagnosis and individual needs.
When the decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, others who have charge of the child) is essential. Children should be watched and questioned for side effects. Many children, especially younger ones, do not volunteer information. They also should be monitored to see that they are actually taking the medication and taking the proper dosage.
Stimulants are one type of medication. Three stimulants — methylphenidate (Ritalin); dextroamphetamine (Dexedrine); and pemoline (Cylert) are more commonly prescribed for children than adults. They are successfully used in the treatment of attention-deficit/hyperactivity disorder (ADHD).
ADHD is a disorder usually diagnosed in early childhood in which the child exhibits such symptoms as short attention span, excessive activity, and impulsivity. A child with ADHD should take a stimulant medication only on the advice and under the careful supervision of a physician.
The use of medications in children is more limited than with adults. Commonly used psychotropic medications that have specific indications and dose guidelines for children are listed in the Physicians’ Desk Reference.
The Elderly — People over the age of 65 make up 12 percent of the population of the United States, yet they receive 30 percent of prescriptions filled. The elderly generally have more medical problems and often are taking medications for more than one of these problems.
In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication.
The elderly sometimes may accidentally take too much of a medication because they forget that they have taken a dose. The use of a 7-day pill box is especially helpful to an elderly person.
The elderly and those close to them — friends, relatives, caretakers — need to pay special attention and watch for adverse (negative) physical and psychological responses to medication. Because they often take more medications — not only those prescribed but also over-the-counter preparations and home or folk remedies — the possibility of negative drug interactions is higher.
Pregnant, Nursing or Childbearing-Age Women — In general, during pregnancy, all medications (including psychotherapeutic medications) should be avoided where possible, and other methods of treatment should be tried.
A woman who is taking a psychotherapeutic medication and plans to become pregnant should discuss her plans with her doctor; if she discovers that she is pregnant, she should contact her doctor immediately. During early pregnancy, there is a possible risk of birth defects with some of these medications, and for this reason:
- Lithium is not recommended during the first three months of pregnancy.
- Benzodiazepines are not recommended during the first three months of pregnancy.
The decision to use a psychotherapeutic medication should be made only after a careful discussion with the doctor concerning the risks and benefits to the woman and her baby.
Small amounts of medication pass into the breast milk; this is a consideration for mothers who are planning to breast-feed.
A woman who is taking birth-control pills should be sure that her doctor is aware of this. The estrogen in these pills may alter the breakdown of medications by the body, for example increasing side effects of some antianxiety medications or reducing their ability to relieve anxiety symptoms.
For more detailed information, talk to your doctor or mental health professional, consult your local public library, or write to the pharmaceutical company that produces the medication.