Childhood Habit Behaviors and Stereotypic Movement Disorder Medication

  • Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Apr 30, 2012
 

Medication Summary

Most common habits in children that require treatment can be substantially improved with behavioral interventions, without the use of medication. However, in some cases, medication in addition to behavioral treatments may be required to attain optimal treatment outcomes. Agents that may be used include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

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Antidepressants, SSRIs

Class Summary

These are antidepressant agents chemically unrelated to the tricyclic, tetracyclic, or other available antidepressants. Inhibits CNS neuronal uptake of 5HT. They may also have a weak effect on norepinephrine and dopamine neuronal reuptake.

SSRIs are greatly preferred over the other classes of antidepressants. Because the adverse-effect profile of SSRIs is less prominent than that of other agents, they promote compliance. SSRIs do not have the risk of cardiac arrhythmia associated with tricyclic antidepressants. The risk of arrhythmia is especially pertinent in overdose, and a suicide risk must always be considered when a child or adolescent with a mood disorder is being treated.

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Fluoxetine (Prozac)

 

Fluoxetine selectively inhibits presynaptic serotonin reuptake with minimal or no effect on reuptake of norepinephrine or dopamine. It is approved for obsessive-compulsive disorder in children aged 8 years or older.

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Sertraline (Zoloft)

 

Sertraline selectively inhibits presynaptic serotonin reuptake. It is approved for obsessive-compulsive disorder in children aged 6 years or older.

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Fluvoxamine (Luvox)

 

Fluvoxamine is a potent selective inhibitor of neuronal serotonin reuptake. It does not notably bind to alpha-adrenergic, histamine, or cholinergic receptors and therefore has fewer adverse effects than TCAs do. It is approved for obsessive-compulsive disorder in children aged 8 years or older.

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Antidepressants, TCAs

Class Summary

TCAs are structurally related to the phenothiazine antipsychotic agents and have 3 major pharmacologic actions, in varying proportions:

  • Inhibition of the amine pump
  • Sedation
  • Peripheral and central anticholinergic action

These drugs inhibit the reuptake of norepinephrine or serotonin at the presynaptic neuron.

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Clomipramine (Anafranil)

 

Clomipramine is a dibenzazepine compound belonging to the TCA family. It affects serotonin uptake, and its metabolite, desmethylclomipramine, affects norepinephrine uptake. It is approved for obsessive compulsive disorder in children aged 10 years and older.

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Opioid Reversal Agents

Class Summary

Opioid antagonists may block the euphoria from self-injurious behaviors and other stereotypies.

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Naltrexone (ReVia, Vivitrol)

 

Naltrexone is an opioid receptor competitive antagonist with high affinity for mu receptors. It may diminish the euphoria effects resulting from endogenous opioidlike agents released during self-injurious behavior.

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Contributor Information and Disclosures
Author

Cynthia R Ellis, MD  Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center

Cynthia R Ellis, MD is a member of the following medical societies: Nebraska Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Connie J Schnoes, MA, PhD  Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town

Disclosure: Nothing to disclose.

Holly Jean Roberts, PhD  Assistant Professor, Department of Pediatrics, Munroe-Meyer Institute, University of Nebraska Medical Center

Holly Jean Roberts, PhD is a member of the following medical societies: Autism Society of America, National Association of School Psychologists, and Psi Chi

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Robert J Baumann, MD Professor of Neurology and Pediatrics, Department of Neurology, University of Kentucky College of Medicine

Robert J Baumann, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, and Child Neurology Society

Disclosure: Nothing to disclose.

Vamsi Krishna Chinthapalli, MBBS, MRCP Specialty Registrar in Neurology, National Hospital for Neurology and Neurosurgery, UK

Disclosure: Nothing to disclose.

Chet Johnson, MD Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Amy Kao, MD Assistant Professor, Department of Pediatrics, Division of Pediatric Neurology, Department of Neurology, Oregon Health and Science University; Consulting Staff, Shriners Hospital for Children

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society

Disclosure: Nothing to disclose.

Harvey S Singer, MD Director, Division of Pediatric Neurology, Haller Professor of Pediatric Neurologic Diseases, Department of Neurology, Professor of Pediatrics, Department of Pediatrics, Johns Hopkins University School of Medicine; Clinical Professor, Department of Neurology, University of Maryland School of Medicine; Consulting Staff, Kennedy Krieger Institute and Mt Washington Pediatric Hospital

Harvey S Singer, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Academy of Pediatrics, American Neurological Association, and Child Neurology Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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