Currently, SSRI antidepressants are recommended as first-line drugs to treat depression in children and adolescents. Fluoxetine (from 8 years of age) has proven clinical efficacy for use in children. This drug, along with escitalopram (approved for use since the age of 12), is recommended by the U.S. Food and Drug Administration (FDA) to treat depression in adolescence. Other drugs from this group may also be recommended for use – paroxetine and citalopram, as well as SNRIs (venlafaxine).
Based on categories of evidence (A – controlled trials in children/adolescents; B – controlled trials in adults; C – open-label trials in children/adolescents and retrospective analyses; D – case descriptions, expert opinion) the effectiveness of treating type I bipolar disorder in children and adolescents considering additional aspects (for example, safety, tolerability, and possible interactions), the following therapy algorithms can be recommended. For the treatment of acute bipolar, I type with a manic or mixed episode without psychotic symptoms at the first stage, monotherapy with normotimics (lithium (A, B), valproic acid (B, C), carbamazepine (B)), and A.A. (olanzapine (B, C), quetiapine (B, C), risperidone (B, C)). For the treatment of acute bipolar, I type with a manic or mixed episode with psychotic symptoms at the first stage, it is recommended to use a normotimic agent (lithium (A, B), valproic acid (B, C), carbamazepine (B)) in combination with A.A. (olanzapine (B, C), quetiapine (B, C), risperidone (B, C)). With a partial response, it is recommended to attach lithium or another normotimic, if it has not been previously used (lithium + valproic acid + A.A.; lithium + carbamazepine + A.A.).
Randomized controlled trials have demonstrated that behavioral therapy for ADHD is less effective than stimulant drug therapy in school-aged children, and behavioral or combination therapy is better recommended for preschool children. CNS stimulants are used to treat ADHD in children in the United States. Anxiolytics, usually selective serotonin reuptake inhibitors (SSRIs), are used to treat pediatric anxiety disorder. Buspirone is sometimes used in children who cannot tolerate SSRIs; however, it is much less effective. The initial dose of buspirone is 5 mg orally two times a day; the dose can be gradually increased to 30 mg 2 times a day (or 20 mg three times a day) depending on tolerance. Gastrointestinal distress or headache may be the limiting factor with increasing dosage.
The treatment of mental conditions in children and adults is rather similar, and the difference lies only in the dosage of drugs and the tendency to prefer psychotherapy without the use of drugs in mild cases. Medical correction should be based on the age-related aspects of pediatric psychopharmacotherapy, promote the process of optimal development of the child and the maturation of the structures and functions of the brain.
