Pharmacotherapy of disorders of adolescents

Despite the increase in the diversity of Axis I disorders that can appear during adolescence, the psychopharmacology treatment literature is just now focusing on their special needs and response patterns. Several findings, such as the secular increase in suicide completion among male adolescents and the lack of controlled data showing tricyclic antidepressant efficacy in this age group, underscore the unique response of adolescents to drug treatment plans that have been successful with younger and older patients. The positive response to psychostimulants for adolescents with ADHD resembles that seen in younger children. On the other hand, the great increase in suicidal behavior, particularly overdoses, that occur in patients over 12 years of age makes the choice of a nonlethal (in intentional overdose) antidepressant a critical matter. Female patients who are younger seem to achieve higher blood levels than male patients, and also show more side effects for the same weight-adjusted dose. When one adds the developmental issues of this life stage, namely the need for separation and individuation, to the complications of prescribing medications, office practice and drug management become more complicated and require a strong therapeutic alliance to ensure good compliance. These issues make the use of psychotropic medications in adolescent patients challenging and complicated, but ultimately rewarding for those clinicians who can combine psychopharmacologic knowledge with good interpersonal therapeutic skills.