Safety of Psychotropic Drugs in Children and Adolescents

Abstract

The recent rise in the use of psychotropic drugs to treat mental disease in children and adolescents has not been accompanied by quality research evidence on their efficient and safe use in this population. Currently, 60–70 % of pharmacological prescriptions in pediatric psychiatry are considered “off label,” that is, used in age ranges, doses, and indications that are not approved by regulatory authorities. In addition, children and adolescents exposed to psychotropic drugs may be at higher risk than adults for certain adverse events such as metabolic and endocrine abnormalities associated with second-generation antipsychotic treatments. They may also present adverse events not previously assessed in adults such as growth delay with chronic use of methylphenidate. As psychotropic drugs are prescribed to control clinical symptoms in long-lasting psychiatric disorders, specific attention should be paid on the detection of delayed adverse events due to exposure during childhood. Further research should also elucidate the physiopathological mechanisms of psychotropic-induced toxicity and the potential value of personalized approaches based on genetics and neurobiology. In conclusion, additional safety data are urgently needed to clarify the risk-benefit ratio of psychotropic medications in children and adolescents and to adequately guide medical decision-making.