Introduction

This is the online version of the popular Clinical Handbook of Psychotropic Drugs for Children and Adolescents, currently in its 4th print edition.

The Clinical Handbook of Psychotropic Drugs for Children and Adolescents is intended to be a user-friendly and practical resource guide for those who prescribe, dispense, and administer psychotropic drugs to children and adolescents. Its content is derived from various forms of published literature (including randomized controlled trials (RCTs), meta-analyses, scientific data such as pharmacokinetic trials, cohort trials, case series, and case reports) as well as from leading clinical experts. We endeavor to continually update this handbook as the psychiatric literature evolves so we can continue to provide evidence-based clinically relevant information that is easily accessed and utilized to aid with patient care decisions. New sections, periodically added, reflect changes in therapy and in current practice.

The purpose of this handbook is to provide quick access to relevant, practical, and important information clinicians should be aware of when considering pharmacological options available in the treatment of childhood and adolescent psychiatric disorders. It provides an overview of the plausible alternatives, dosing guidelines, as well as information on drug interactions and potential side effects. It is meant to be a resource to both those in training and experienced clinicians.

Most children and adolescents with a diagnosable psychiatric disorder require multimodal interventions to address the symptoms of the disorder, the comorbid conditions, and the psychological, social, and developmental sequelae. Individual and family psychoeducation are essential, and psychosocial interventions should be considered for most psychiatric disorders before, or concurrently with pharmacotherapy.

While initially many classes of psychotropic drugs were used to treat childhood and adolescent mental illness on the basis of efficacy in adults, much more published evidence has become available in this age group in recent years. The lack of regulatory approval in a country does not necessarily reflect lack of safety or efficacy or controlled studies in these age groups. While many product monographs include a statement that a drug has not been adequately studied in children and the safety of the drug has not been established under a specific age, published RCT evidence supporting safety and efficacy may be available.

In the Product Availability section of each chapter, the Clinical Handbook includes monograph statements regarding the recommendations for the use of each drug in children and adolescents. Approved indications for children are stated, as are those for adults; also included are unapproved (also called off-label) indications for these drugs. Each chapter includes data from open and double-blind studies, where available, regarding dosing, adverse effects, monitoring, and other important considerations in children and adolescents.

Given that changes may occur in a medication's indications, and differences are seen among countries, specific “indications” listed in this text as “approved” should be viewed in conjunction with product monographs approved in your jurisdiction of interest.

Because of a lack of comparative data in children and adolescents for most drug classes, Adverse Reaction tables and Drug Interaction charts reflect information that pertains to heterogeneous age groups (youth and adults).

Until systematic double-blind studies of various psychotropic drugs have been conducted to determine the efficacy, the pharmacokinetics, as well as the relative and absolute risks of each drug in this population, prescribers who choose to use specific psychotropic drugs in children and adolescents should review all available studies and monitor their patients on a regular basis. Consideration should be given to obtaining informed consent from the caregiver or youth (depending on the pateint's age) for use in unapproved indications.

Dose comparisons and plasma levels are based on scientific data. However, it is important to note that some patients will respond to doses outside the reported ranges. Age, sex, and the medical condition of the child or adolescent must always be taken into consideration when prescribing any psychotropic agent.

Patient and Caregiver Information Sheets for most drug categories are provided as printable pdf files to facilitate education/counselling of patients receiving these medications and their caregivers. For details, please see here.

Instantly recognizable icons and color coding, search and browse features, charts and column-selector enhanced tables of comparisons are employed to enable the reader to have quick access to information.

Over the years, readers have asked many interesting questions and provided useful comments and suggestions regarding the content and format of the handbook. This input is critical to keeping this handbook current, accurate, and relevant to the readership. We appreciate readers' feedback, so we invite you to send e-mail to the address below with your comments and questions.

Dean Elbe
E-mail: DElbe@cw.bc.ca