1. Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Medications: The Basics
David Gardner
Denise Rowe
2. Declaration
We don’t know what you know
We don’t know what you do day to day
We don’t know what you want to know
But….
We know stuff about medication and mental illness
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
3. “Top of Mind” Issues
Side effects
Target Symptoms
Time to onset
Chance of benefiting/being harmed
Interaction with licit and illicit substances
Monitoring
Tools/resources
Case Examples
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
4. Med Ed
Medication Education for Promoting Mental Wellness
A Guide for Young People and Those Who Care for Them
http://teenmentalhealth.org/resources/entries/med-ed-bookletd
5. Med Ed Passport
Covers:
- Youth oriented
- Uninformative, subtle title
Med Ed booklet
5
9. Prevailing Attitudes Toward Psychotropic
Medication in Young People
Email Jun 28, 2012
Dr. Gardner:
I got the flyer for the Halifax workshop for teen mental health. I was
wondering how you could possibly promote psychotropic drugs for
teens. You know the side effects and you also no doubt know that they
work no better than a placebo. You also know that many of the studies
are funded by pharmaceutical companies and are ghost written and this
is passed off as "evidence-based medicine". …
I was wondering how you can promote "mental health" as the drugging
of children and their possible assault with electroconvulsive shock, and
you don't mind getting people of child-bearing age addicted to drugs
which can affect the unborn child.
How, in all conscience, can you do this?
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
10.
Antidepressants
bupropion citalopram escitalopram fluoxetine paroxetine sertraline
Uses Time to See Common Serious Other
Effect Side Effects Side Effects
• Depression • Improved • Sedation • Thoughts of • Can cause side
• Anxiety disorders sleep, appetite, • Headache hurting oneself or effects/
• Obsessive energy: 2-4 • Dizziness suicide withdrawal
compulsive weeks • Dry mouth • Abnormal bleeding reaction when
disorder • Depressed • Nausea, • Serotonin stopped quickly
• Panic disorder mood, loss of vomiting and syndrome • Drug
• Eating disorders pleasure, diarrhea interactions
• Sleep problems pessimism, • Sweating
irritability: 4-8 •Sexual
weeks dysfunction
• Return of
functioning:
months
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
11. Antidepressants:
Common Side Effects
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
13.
Antipsychotics
Aripiprazole Asenapine Clozapine Iloperidone Olanzapine Quetiapine Risperidone Ziprasidone
Uses Time to See Effect Common Serious Other
Side Effects Side Effects
•Psychosis • Hyperactivity, • Sedation • Severe muscle • Maintenance
•Bipolar disorder hostility, agitation • Headache spasms therapy may
•Disruptive and aggression: • Dry mouth • Neuroleptic reduce risk of
behaviour 1 week • Constipation Malignant relapse
disorders • Delusions, • Weight gain Syndrome
• Aggression hallucinations: • Sexual •Diabetic
•Tourette’s 4-8 weeks dysfunction emergencies
• Negative •Movement • Seizures
symptoms (eg. problems
lack of interest):
months
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
14.
Mood Stabilizers
Lithium Valproic Acid Lamotrigine
Uses Time to See Effect Common Serious Other
Side Effects Side Effects
• Bipolar disorder • Acute mania: • Sedation • Blood problems; • Patients will
• Agitation 7-28 days • Headache may present as likely be on
• Aggression • Antidepressant • Dizziness bleeding or medications long-
•Seizures effects: • Nausea, bruising easily term
6-8 weeks vomiting and • Severe skin rash •Mood stabilizers
diarrhea with fever can interact with
• Weight gain OTCs (e.g. pain
• Tremor relievers like
• Increased thirst ibuprofen)
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
15.
Stimulants
atomoxetine d-amphetamine methylphenidate modafinil
Uses Time to See Effect Common Serious Other
Side Effects Side Effects
• Attention Deficit • Efficacy can be • Headache • Fast or • Dosing regimen
Hyperactivity seen right away • Insomnia pounding heart can be tailored to
Disorder (ADHD) with the first • Irritability beat suit the
• Aggression dose (within 1 • Nausea, • Weight loss needs/lifestyle of
• Help with social hour) vomiting and • Slowed growth each patient
interactions • Non-stimulants diarrhea • Tics or abnormal • If reduced
used to treat • Decreased movements appetite or
ADHD can take appetite • Hallucinations weight loss –
longer (2-4 recommend high
weeks) calorie snacks or
take after meal
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
16. Anti-anxiety and Sleep Medications
Benzodiazepines (benzo’s) Trazodone Zopiclone
Uses Time to See Effect Common Serious Other
Side Effects Side Effects
• Sleep • Antidepressants: • Sedation • Seizures • Benzo’s can cause
• Anxiety 4-8 weeks • Headache • Confusion rebound anxiety/
• Agitation • Benzodiazepines: • Dizziness • Thoughts of withdrawal symptoms
• Treat side 1-2 hrs; not • Dry mouth hurting when stopped quickly
effects of recommended for • Nausea, oneself or • Avoid driving and
antipsychotics long term use vomiting and suicide other activities that
diarrhea • Abnormal require quick thinking
• Sweating bleeding and reaction
• Serotonin
syndrome
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
17.
How do you know if the
medication is doing more good
than harm?
Selection Monitoring Combining
Dose adjusting Side effect management Stopping
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
19.
Activity Tracker
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
20.
Side Effect Tracker
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
21.
Prescriber Checklist Tool
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
22. Issues Worth Discussing Further:
•Over sedation / cloudy thinking
•Dosing: too high/too low
•Addiction to meds / misuse / diversion
•MJ, alcohol, other substances of abuse
•Lack of effectiveness
•Pushing pills (family, health providers, teachers)
•Confidentiality
•Teacher’s / school’s role
•Other
23. Resources
Medications for Mental Health
http://teenmentalhealth.org
Search: Med Ed
http://heretohelp.bc.ca/
Excellent source for mental illness and drug (prescription and illicit)
information
First person accounts and blogs
Multilingual
Timothy E. Wilens. Straight Talk About Psychiatric Medications for Kids, 3 rd
edition. Guilford Press: NY; 2009.
Kalyna Z. Bezchlibnyk-Butler, et al. Clinical Handbook of Psychotropic
Drugs for Children and Adolescents. 2007
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
PEI CE day Oct 2007 Be Flexible, Be Creative: Some youth may want to use the larger booklet exclusively (at home as well as at all appointments) while other may prefer the passport as their main Med Ed resource. The Med Ed resources should be used in a way that maximizes their value and fits the youth’s preferences and needs. When one of the resources is finished (gets filled up or is damaged or is lost) replace it with a new one. Ideally, keep older completed Med Ed resources in a safe place as they can help to keep a record about medications for that person. These youth-focused resources are not intended to replace appropriate documentation practices by health providers, in patient charts for example.
Serotonin Syndrome (rapid onset of fever, sweating, problems with reflexes, shaking, problems with balance and movements, and confusion) Health providers should be informed about thoughts of hurting oneself or suicide.
Med Ed - common SE
Disruptive behaviour disorders includes: ADHD, ODD and conduct disorder Refer to KT session - later in the afternoon Neuroleptic Malignant Syndrome (stiff muscles, sudden confusion, high fever, irregular blood pressure and heart rate)
- Is everyone aware of what OTCs are? - medications that you don’t need a prescription for. Importance of talking to the pharmacist to check for interactions.