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 antidepressants, mood stabilizers, typical and atypical antipsychotics. [37] Currently, there is no medication that is FDA approved for stereotypic movement disorder, and all use is off-label.
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.
Sertraline (Zoloft)
Sertraline selectively inhibits presynaptic serotonin reuptake.
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.
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.
Citalopram (Celexa)
Citalopram enhances serotonin activity due to selective reuptake inhibition at the neuronal membrane.
Escitalopram (Lexapro)
This agent is a selective serotonin reuptake inhibitor (SSRI) and an S-enantiomer of citalopram. 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.
Antidepressants, TCAs
Class Summary
TCAs are structurally related to the phenothiazine antipsychotic agents and have 3 major pharmacologic actions, in varying proportions including: inhibition of the amine pump, sedation, and 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.
Mood Stabilizers
Divalproex sodium (Depakote, Depakote ER, Depakote Sprinkles)
Mechanism of action is somewhat unclear, but traditionally has been thought to block voltage-gated sodium channels and increase brain levels of gamma-aminobutyric acid (GABA).
Antipsychotics, 2nd Generation
Risperidone (Risperdal, Perseris, Risperdal Consta)
Acts as a D2 antagonist, Serotonin 2A and 5HT7 antagonist.
Aripiprazole (Abilify)
Works as a partial agonist of D2 and 5HT1A, as well as blockade effects of serotonin type 2A, 2C, and 7 receptors.
ADHD Agents
Atomoxetine (Strattera)
Mechanism of action is as a norepinephrine reuptake inhibitor.
