gardner academy jul_2012,_drug_use_and_abuse-1[1]

Academy in School Mental HealthPresented by: Sun Life Financial Chair in Adolescent Mental Health

Medications: The BasicsDavid GardnerDenise Rowe

Declaration

Academy in School Mental Health

Presented by: Sun Life Financial Chair in Adolescent Mental Health

We don’t know what you knowWe don’t know what you do day to dayWe don’t know what you want to knowBut….

We know stuff about medication and mental illness

“Top of Mind” Issues



Side effectsTarget SymptomsTime to onsetChance of benefiting/being harmedInteraction with licit and illicit substancesMonitoringTools/resourcesCase Examples

Med EdMedication Education for Promoting Mental Wellness

A Guide for Young People and Those Who Care for Them

http://teenmentalhealth.org/resources/entries/med-ed-bookletd

5Med Ed booklet

Med Ed Passport

Covers:

- Youth oriented

- Uninformative, subtle title

Medications for Mental Illness and Symptoms

aripiprazole Abilify

Prevailing Attitudes Toward Psychotropic Medication in Young People



Email Jun 28, 2012Dr. 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?

Antidepressantsbupropion citalopram escitalopram fluoxetine paroxetine sertraline



Uses Time to See Effect

Common Side Effects

SeriousSide Effects

Other

• Depression• Anxiety disorders • Obsessive compulsive disorder• Panic disorder • Eating disorders • Sleep problems

• Improved sleep, appetite, energy: 2-4 weeks• Depressed mood, loss of pleasure, pessimism, irritability: 4-8 weeks• Return of functioning: months

• Sedation• Headache• Dizziness• Dry mouth• Nausea, vomiting and diarrhea • Sweating•Sexual dysfunction

• Thoughts of hurting oneself or suicide• Abnormal bleeding • Serotonin syndrome

• Can cause side effects/ withdrawal reaction when stopped quickly• Drug interactions

Antidepressants: Common Side Effects



Antidepressants



AntipsychoticsAripiprazole Asenapine Clozapine Iloperidone Olanzapine Quetiapine Risperidone Ziprasidone



Uses Time to See Effect Common Side Effects

SeriousSide Effects

Other

•Psychosis•Bipolar disorder•Disruptive behaviour disorders• Aggression •Tourette’s

• Hyperactivity, hostility, agitation and aggression: 1 week• Delusions, hallucinations:4-8 weeks• Negative symptoms (eg. lack of interest): months

• Sedation • Headache• Dry mouth• Constipation• Weight gain• Sexual dysfunction•Movement problems

• Severe muscle spasms • Neuroleptic Malignant Syndrome•Diabetic emergencies• Seizures

• Maintenance therapy may reduce risk of relapse

Mood StabilizersLithium Valproic Acid Lamotrigine




SeriousSide Effects

Other

• Bipolar disorder • Agitation • Aggression•Seizures

• Acute mania: 7-28 days• Antidepressant effects: 6-8 weeks

• Sedation• Headache • Dizziness • Nausea, vomiting and diarrhea• Weight gain• Tremor • Increased thirst

• Blood problems; may present as bleeding or bruising easily• Severe skin rash with fever

• Patients will likely be on medications long-term•Mood stabilizers can interact with OTCs (e.g. pain relievers like ibuprofen)

Stimulantsatomoxetine d-amphetamine methylphenidate modafinil




SeriousSide Effects

Other

• Attention Deficit Hyperactivity Disorder (ADHD)• Aggression • Help with social interactions

• Efficacy can be seen right away with the first dose (within 1 hour)• Non-stimulants used to treat ADHD can take longer (2-4 weeks)

• Headache• Insomnia • Irritability • Nausea, vomiting and diarrhea• Decreased appetite

• Fast or pounding heart beat• Weight loss • Slowed growth• Tics or abnormal movements• Hallucinations

• Dosing regimen can be tailored to suit the needs/lifestyle of each patient • If reduced appetite or weight loss – recommend high calorie snacks or take after meal

Anti-anxiety and Sleep MedicationsBenzodiazepines (benzo’s) Trazodone Zopiclone




SeriousSide Effects

Other

• Sleep• Anxiety • Agitation • Treat side effects of antipsychotics

• Antidepressants: 4-8 weeks• Benzodiazepines:1-2 hrs; not recommended for long term use

• Sedation• Headache• Dizziness• Dry mouth• Nausea, vomiting and diarrhea • Sweating

• Seizures• Confusion • Thoughts of hurting oneself or suicide• Abnormal bleeding • Serotonin syndrome

• Benzo’s can cause rebound anxiety/ withdrawal symptoms when stopped quickly• Avoid driving and other activities that require quick thinking and reaction

How do you know if the medication is doing more good

than harm?



Selection Monitoring Combining

Dose adjusting Side effect management Stopping

Symptom Tracker



Activity Tracker



Side Effect Tracker



Prescriber Checklist Tool



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

ResourcesMedications for Mental Health



http://teenmentalhealth.orgSearch: Med Ed

http://heretohelp.bc.ca/ Excellent source for mental illness and drug (prescription and illicit) informationFirst person accounts and blogsMultilingual

Timothy E. Wilens. Straight Talk About Psychiatric Medications for Kids, 3rd edition. Guilford Press: NY; 2009.Kalyna Z. Bezchlibnyk-Butler, et al. Clinical Handbook of Psychotropic Drugs for Children and Adolescents. 2007

http://teenmentalhealth.org/

http://heretohelp.bc.ca/

Discussion



gardner academy jul_2012,_drug_use_and_abuse-1[1]

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