Tailor Psychotropic Drugs to Reduce Side Effects

By Hurley, Dan | Clinical Psychiatry News, March 2010 | Go to article overview

Tailor Psychotropic Drugs to Reduce Side Effects


Hurley, Dan, Clinical Psychiatry News


NEW YORK--A wealth of new data is emerging that will help clinicians anticipate and manage endocrine complications of psychotropic drugs, according to a leading researcher.

"We can't take a gene chip and come up with firm recommendations," said Dr. Harold E. Carlson, who has published widely in the field as professor of medicine and endocrinology at Stony Brook (New York) University Health Sciences Center. But based on new data, he said, "We can think about individualized pharmacotherapy tailored to your patients' needs."

Reduced height and weight in children and adolescents taking stimulants for attention-deficit/hyperactivity disorder (ADHD) has been a concern for years, and the latest data from the Multimodal Treatment of ADHD (MTA) Study suggest that growth deficits of about 1 inch persist after 8 years of treatment (J. Am. Acad. Child Adolesc. Psychiatry 2009; 48: 484-500.)

"We still do not have published data on the final adult height of children who have been treated continuously from childhood with stimulants," Dr. Carlson said at a psychopharmacology update, sponsored by the American Academy of Child and Adolescent Psychiatry (AA-CAP). "The MTA study is nearing the point where most of the subjects will reach their final adult type. So far, [co-principal investigator] Jim Swanson tells me they remain about 1 inch shorter than they should otherwise be. They may wind up with a permanent growth deficit."

On the other hand, permanent growth deficits were not observed in a study of atomoxetine (J. Child Adolesce. Psychopharmacol. 2007; 17: 689-700). In the study of 61 children treated for 5 years, initial slowing of growth was followed by a period of catch-up, such that height was usually normal by the fourth or fifth year.

Individual characteristics of patients can alert clinicians to those who might be at increased risk of reduced growth, Dr. Carlson noted. Prepubertal children have more slowing of growth than do adolescents; boys have more slowing than do girls; and children who are tall or overweight at the inception of treatment are at greater risk of slowed growth than shorter, underweight children.

The bottom line, Dr. Carlson said, is that all children and adolescents need to have their height and weight measured before beginning stimulant treatment.

"Do it yourself, or get it from the pediatrician," he said. "Get the growth charts. And then someone should measure height and weight every 6 to 12 months. If the kid seems to be falling off his or her growth curve, and it's a substantial amount, then I think it's time to speak to the pediatrician and consider referring to a pediatric endocrinologist."

Dr. Carlson urged physicians to use the lowest effective dose, to avoid giving short-acting stimulants just before meals, and to provide high-energy snacks or meals when the appetite is least suppressed.

"Work with the family," he said. "If the kids' last dose is in the late afternoon, try having them give a wonderful bedtime snack."

The opposite metabolic effect--weight gain associated with antipsychotics--has been confirmed in multiple studies cited by Dr. Carlson, including one study (J. Am. Acad. Child Adolesc. Psychiatry 2002; 413: 337-43) showing that olanzapine and risperidone are both associated with "extreme" weight gain in adolescents. The best defense against such unwanted effects, he said, is a good offense.

"You're going to want to calculate the child's BMI before you begin treatment, and then monitor it at every visit," he said. "Provide counseling on diet and exercise from the start. It's much harder to take it off than to prevent it. Structured programs work best. If weight is progressing quickly, try switching medications to one less associated with weight gain. In resistant cases, pharmaceutical therapies have been used to promote weight loss, such as orlistat or metformin."

Sudden cardiac death is another risk to consider when prescribing stimulant medications for ADHD, Dr.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Tailor Psychotropic Drugs to Reduce Side Effects
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.