THIS IS IMPORTANT INFORMATION
Please remember as a foster parent you must have permission from social worker to start or change meds.
Tip of the Day: Psychotropic Medications—Depression
Children and adolescents in state custody have experienced abuse and/or neglect by definition in that they often have chaotic caretak-ing histories with disrupted attachments and multiple placements. Additionally, they may be genetically predisposed to mental illness and have been exposed in utero to substances of abuse. Not surprisingly, children in foster care are at higher risk for developing emo-tional and behavioral disturbances and mental illness, utilize mental health services at higher rates, and are more likely to receive psy-chotropic medications than youth from comparable backgrounds.
Psychotropic medications are drugs that affect the mind, perception, behavior and mood. Common types of psychotropic drugs that are prescribed by physicians include:
Antidepressants – Anxiolytics or anti-anxiety agents – Antipsychotics – Mood stabilizers
Other substances can be considered psychotropic drugs as well, including alcohol, marijuana and street drugs. Medications used for ADHD are also considered psychotropic drugs.
Depression is commonly treated with antidepressant medications. Antidepressants work to balance some of the natural chemicals in our brains. These chemicals are called neurotransmitters, and they affect our mood and emotional responses. Antidepressants work on neurotransmitters such as serotonin, norepinephrine, and dopamine. The most popular types of antidepressants are called selec-tive serotonin reuptake inhibitors (SSRIs). These include:
Fluoxetine (Prozac); Citalopram (Celexa); Sertraline (Zoloft); Paroxetine (Paxil); Escitalopram (Lexapro)
Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and include:
Venlafaxine (Effexor) and Duloxetine (Cymbalta)
Another antidepressant that is commonly used is bupropion (Wellbutrin). Bupropion, which works on the neurotransmitter dopamine, is unique in that it does not fit into any specific drug type.
Antidepressants may cause mild side effects that usually do not last long. Any unusual reactions or side effects should be reported to a doctor immediately. The most common side effects associated with SSRIs and SNRIs include:
Headache – This usually goes away within a few days; Nausea – This usually goes away within a few days; Sleeplessness or drowsiness – which may happen during the first few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects; Agitation (feeling jittery).
In 2005, the FDA decided to adopt a “black box” warning label—the most serious type of warning—on all antidepressant medications. The warning says there is an increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24.
The warning also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. A theory as to why there is an increase in suicidality is that before taking antidepressants, the patient is too depressed to do anything at all; an antidepressant clarifies the thinking such that the depressed patent may actually be able to make a plan to end his or her life. That is why all children in foster care who are depressed should be co-managed with a therapist and a prescribing physi-cian on a regular basis.
Michelle Terry, MD
Ask Dr. Terry
March 8, 2012
All Kids are Our Kids
Michelle Terry, MD
Medical Consultant, Region 5, DSHS