Perspectives in pediatric psychopharmacology.

Sir,

There is a rising prevalence of psychiatric disorders in children and adolescents. Global trends in pediatric psychopharmacology show a mounting evidence for the effectiveness of psychiatric medications for common pediatric psychiatric disorders. It is necessary to translate advances in child and adolescent psychopharmacology into clinical practice. Prescription of psychiatric medications in pediatric population requires a thorough understanding of the pharmacokinetic and pharmcodynamic aspects of specific drugs, developmental considerations of pediatric metabolism, drug interactions, and adverse effects. The existing scientific literature highlights that about 75% of the psychotropic drugs prescribed for children and adolescents have not been tested in well controlled trials. Weight based dosing is commonly used to calculate the necessary dosage for pediatric population as a step down model from evidences available in adult psychopharmacological literature.[1] Pejovic-Milovancevic et al. conducted a study on use of psychotropic medication in pediatric inpatients and found that the most commonly prescribed medications were antipsychotics (45.9%), antidepressants (17.2%), mood stabilizers (16.1%), benzodiazepines (14.4%), and other psychotropic drugs (6.4%). Their study also showed that the most frequently prescribed antipsychotic was Risperidone and the most frequently prescribed antidepressant was selective serotonin reuptake inhibitor (SSRI).[2] Research in pediatric psychopharmacology has expanded considerably over the last few decades. However, there are ongoing controversies regarding the effectiveness and safety of commonly used psychotropics and their role in treatment of psychiatric disorders in children. Globally, controlled clinical trials have been conducted in many common psychiatric disorders in children and adolescents. This has further given direction in the development and implementation of evidence-based treatment guidelines. However there has been a relatively slower progress in development of newer drugs and testing exclusively for pediatric population. There are significant concerns regarding safety of psychiatric drugs in children. These factors have had a major influence on clinical practice and drug utilization.[3] The growing use of psychotropic agents in children and adolescents merit a continuous concern with regard to their effects on the developing brain and impact on quality of life.[4] Minors with mental disorders constitute a vulnerable patient group. Hence, research on psychopharmacological treatment in children and adolescents is the subject of ongoing ethical discussion. Considering the important legislative changes in pediatric research over the past decades, there is a need to review recent developments in this area.[5] We believe that there is an enormous need for monitoring the long term side-effects of psychiatric medications in the inherently vulnerable pediatric population. Clinicians and researchers should direct their attention towards the legal, ethical and regulatory aspects of pediatric psychopharmacology. Further studies assessing the trends and prescription patterns of pediatric psychiatric drugs in hospital and community settings are necessary.