Special Considerations

Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing.

Children

Studies consistently show that about 15 percent of the US population below age 18, or over 9 million children, have been diagnosed with a psychological problem that compromises their ability to function. In children, these disorders may present symptoms that are different or less clear-cut than the same disorders in adults. Younger children, especially, may not talk about what’s bothering them, but this is sometimes a problem with older children as well. For this reason, having both a physician and psychologist evaluate the child is especially important.

There are many psychological treatments that can help children. These include psychotherapy, behavioral therapy, social skills training, parental and family therapy, group therapy and medications. The treatment, or combination of treatments, used for an individual child is based on the child’s diagnosis and individual needs. When your child appears to have a psychological problem, it is very important to consult with a psychologist to determine what should be done.

If a decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, others who have charge of the child) is essential. Children should be watched and questioned for side effects (many children, especially younger ones, do not volunteer information). They should also be monitored to see that they are actually taking the medication and taking the proper dosage.

The use with children of the medications described here is more limited than with adults. In the list of medications, those that have specific indications and dose guidelines for children, as listed in the Physicians’ Desk Reference, are indicated by a double asterisk (**).
The Elderly

Persons over the age of 65 make up 12 percent of the population of the United States, yet they receive 30 percent of prescriptions filled. The elderly generally have more medical problems and often are taking medications for more than one of these problems. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication.

The elderly may sometimes accidentally take too much of a medication because they forget that they have taken a dose and take another dose. The use of a 7-day pill box is especially helpful to an elderly person.

The elderly, their friends, relatives, and caretakers, need to watch for adverse (negative) physical and psychological responses to medication. Because the elderly often take more medications (prescribed, over-the-counter drugs, and home or natural remedies), the possibility of negative drug interactions is higher.
Pregnant, Nursing, or Childbearing-Age Women

In general, during pregnancy, all medications (including psychotherapeutic medications) should be avoided where possible, and other methods of treatment should be tried.

A woman who is taking a psychotherapeutic medication and plans to become pregnant should discuss her plans with her doctor; if she discovers that she is pregnant, she should contact her doctor immediately. During early pregnancy, there is a possible risk of birth defects with some of these medications, and for this reason:

1) Lithium is not recommended during the first 3 months of pregnancy.

2) Benzodiazepines are not recommended during the first 3 months of pregnancy.

The decision to use a psychotherapeutic medication should be made only after a careful discussion with the doctor concerning the risks and benefits to the woman and her baby. Small amounts of medication pass into the breast milk; this is a consideration for mothers who are planning to breast-feed.

A woman who is taking birth-control pills should be sure that her doctor is aware of this. The estrogen in these pills may alter the breakdown of medications by the body, and/or reducing their efficacy to relieve symptoms of anxiety.