The Medication Maze

Numerous studies have estimated the increasing prevalence of childhood behavior, mood, and stereotypic movement disorders in the United States to be as many as 1 in 5 children and adolescents. Many of these children respond favorably to medication, showing significant decreases in anxiety and aggressive behaviors and increased levels of positive coping and social interaction skills. A recent multi-site study sponsored by the National Institute of Mental Health (NIMH) and published in the American Journal of Psychiatry found that even children with autism have responded favorably certain medication for up to six months, showing decreased aggression and reduced repetitive behaviors with increased social interaction and limited side effects. Unfortunately, in most cases discontinuation of primarily medicinal treatment regimens result in a rapid return of unstable disruptive and/or aggressive behaviors. However, multi modal treatment regimens involving both medicinal therapies and cognitive/behavioral therapies to teach self monitoring of the environmental and contextual triggers for anxiety, aggression and stereotypical behaviors have a much higher rate of overall stabilization, wherein medication can often be effectively reduced or discontinued as coping strategies are learned and applied to reduce negative symptoms.

The overall effectiveness of medication in treating childhood behavior, mood, and stereotypic movement disorders depends on a number of variables. Thus, it is essential for parents to learn as much as they can about the medication their children are taking, including how and why it works, effective dosages, and estimated durations of the treatment regimens. Before starting any medicinal treatment it is important to remember that no single medication can have the same level of effectiveness for every person, simply because the symptoms of each disability are unique to the individual experiencing them. Also, medications to treat immediate or acute symptoms are often designed to instantly effective, whereas longer lasting maintenance medications take longer to reach a therapeutic level. Different manifestations of disability symptoms can require the combination of two or more medications to provide relief, which adds the concern of possible relative or combined complications (side effects) and contraindications (dangerous reactions to other medications or foods). Finally, even the best medications or combination of medications will not work properly if they are not taken consistently and correctly as prescribed.

There are as many behavior, mood and movement disorder medications as there are pain relievers and antihistamines. Different classes of medications are used to treat different symptoms and result in different levels of side effects:

Mood stabilizers like Lithium are medications that help control the highs and lows of bipolar disorder. They are highly effective for treating mania, but can less effective at treating depressive episodes or mixed episodes. Side effects including weight gain, fatigue, stomach issues, and difficult with memory and concentration.

Anticonvulsants like Tegretol were originally developed for the treatment of epilepsy. They have been effective in treating the symptoms of mania and reducing the intensity of mixed episodes. Side effects include fatigue, weight gain, tremor, stomach issues, and dizziness.

Antidepressants like Risperdal were traditionally developed to treat depression, and have shown some efficacy in reducing the frequency and intensity of some repetitive behaviors. Their use has become controversial due to their tendency to trigger manic episodes and increase mood cycling. Side effects include drowsiness, weight gain, blurred vision and sexual dysfunction.

Antipsychotic drugs may be prescribed if you lose touch with reality during a manic or depressive episode They have also been found to help with regular manic episodes.

Benzodiazepines relieve symptoms of anxiety, agitation, or insomnia. Benzodiazepines are fast-acting sedatives which work within 30 minutes to an hour, but have a high addictive potential.

Calcium Channel Blockers were traditionally used to treat heart problems and high blood pressure and they also been found to have a mood stabilizing effect. They have fewer side effects than traditional mood stabilizers, but they are also less effective.

Thyroid medication also shows promise as a treatment for bipolar depression. Thyroid dysfunction is particularly prevalent in rapidly cycling bipolar disorders. Lithium treatment can also cause low thyroid levels.