Childhood Habit Behaviors and Stereotypic Movement Disorder Medication

Updated: Dec 04, 2015
  • Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD  more...
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Medication

Medication Summary

Most common habits in children that require treatment can be substantially improved by means of behavioral interventions, without pharmacotherapy. 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

SSRIs are antidepressant agents that are chemically unrelated to the tricyclic, tetracyclic, or other available antidepressants. They inhibit central nervous system (CNS) neuronal uptake of serotonin; they may also have a weak effect on norepinephrine and dopamine neuronal reuptake.

SSRIs are greatly preferred to the other classes of antidepressants. Because SSRIs have a less prominent adverse-effect profile than other agents do, their use promotes compliance. SSRIs do not have the risk of cardiac arrhythmia associated with TCAs. 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.

Fluoxetine (Prozac)

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

Sertraline (Zoloft)

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

Fluvoxamine (Luvox CR)

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.

Paroxetine (Paxil, Pexeva)

Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake. It also has a weak effect on norepinephrine and dopamine neuronal reuptake. It is approved for obsessive-compulsive disorder.

For maintenance dosing, make dosage adjustments to maintain patient on lowest effective dosage, and reassess patient periodically to determine need for continued treatment.

Citalopram (Celexa)

Citalopram use is off-label. Citalopram enhances serotonin activity due to selective reuptake inhibition at the neuronal membrane.

Escitalopram (Lexapro)

Escitalopram use is off-label. This agent is a selective serotonin reuptake inhibitor (SSRI) and an S-enantiomer of citalopram that is used for the treatment of depression. Escitalopram enhances serotonin activity because of selective reuptake inhibition at the neuronal membrane. Its mechanism of action is thought to be the potentiation of serotonergic activity in the central nervous system (CNS) through the inhibition of CNS neuronal reuptake of serotonin.

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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.

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.

Naltrexone (ReVia, Vivitrol, Depade)

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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