More children and teens are being treated with daily psychiatric medications, including ADHD medications (most often stimulants) and antidepressants. Practitioners should discuss monitoring children for side effects when prescribing these medications. Following is a list of side effects to look for with psychiatric medications:
Stimulants (methylphenidate and amphetamine families) - typically prescribed as first-line therapy for ADD and ADHD; all stimulants have the following common side effects - weight loss, insomnia (difficulty falling or staying asleep), headaches, stomachaches, dry mouth, dizziness. Dextroamphetamines typically have more associated weight loss than methylphenidates. Stimulants can also, less commonly, cause new psychological symptoms such as irritability, moodiness, depression symptoms, obsessiveness and anxiety. Rarely, stimulants can be associated with hallucinations (visual or tactile) or manic-type symptoms. Overdose can cause heart arrythmias or seizures. Stimulants, as a rule, may raise a child's pulse and blood pressure slightly. This is usually not significant or any cause for concern. Your child's pulse and blood pressure should be monitored by your health provider.
If your child has any new symptoms after starting any of these medications, mention them to your health provider.
Atomoxetine (Strattera) - a nonstimulant used for ADD/ADHD as well; can cause mood swings, irritability, nausea/stomachaches; chance of weight loss and decreased appetite are less than with stimulants; insomnia may occur but is relatively infrequent. Serious but rare side effects may include suicidal thoughts/behavior and liver toxicity. Your provider may order periodic liver enzyme tests (referred to as LFTs) to monitor for any liver side effects.
Clonidine, Guanfacine, Intuniv - blood pressure-lowering medications originally, they are sometimes used for ADD/ADHD. Since they are blood pressure lowering agents, they may cause dizziness, headache and low blood pressure, but the major side effect is sedation. Often, providers will dose these medications in the evening to decrease notable side effects. These medications may also cause dry mouth, nausea, abdominal pain and constipation.
Anti-depressants in the SSRI class - include fluoxetine, sertraline, fluvoxamine, citalopram, escitalopram; as a class, these drugs have similiar side effects but individual patients can vary greatly in their response to certain medications or the side effects they encounter with the specific medication they are taking. The most common side effects include "changes in alertness" (which may be sedation or insomnia), increased or decreased appetite, nausea, constipation, restlessness and headaches. Rarely, some children may have develop a phenomenon known as "behavioral activation" - hypomanic symptoms of impulsivity, agitation, irritability, silliness and mood changes. A serious, but very rare risk is serotonin syndrome - extreme agitation, ataxia, diarrhea, hyperactive reflexes, mental status changes and tremor. Any serious side effects should be reported to your medical provider immediately. There is a "black box warning" for the SSRI class regarding suicide ideation. There have been conflicting studies looking at this topic, but it is important to realize that depressed children who develop suicidal thoughts (medication-related or otherwise) should seek immediate medical attention.
Anti-psychotic medications - most commonly in a class known as "atypical antipsychotics", they seriously but rarely cause extrapyramidal symptoms including muscle rigidity, tremors and muscle tics. More commonly, these medications can cause longer term issues with weight gain, excessive appetite, high blood sugar and high cholesterol. Your medical provider will monitor your child's weight and will order lab work periodically to monitor blood sugar and cholesterol levels. Any significant weight gain is cause for concern and should be discussed with your provider.
It is also important to realize that children who are on two (or more) psychiatric medications are at higher risk for side effects. Safety issues, as well as periodically reassessing the need for medication in general, should be discussed with your medical provider.
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