Monthly
NewsNotes
Monthly NewsNote
November 2007
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Stimulant Side Effects in Children and Adolescents
Last month I was pleased to be part of a presentation on "ADD and Medication Treatments" at a very excellent CACLD conference. I was joined by Dr. Jean Marachi, a fellow psychiatrist working in Fairfield. There was a good deal of dynamic interchange with the audience, and I found that many were extremely interested and concerned about stimulant side effects, particularly relating to children and adolescents. So I thought in this NewsNote I would review the side effects of stimulant medication that parents and therapists need to keep in mind.
1. Reduced appetite and trouble falling asleep. These are the most common side effects created by stimulant medications. However, these do not occur in every case and generally can be managed.
2. Headache, stomachache, irritability, and a sad feeling with weepiness at times. There are a number of fairly common side effects that last a few days and then are often gone. These include headache, stomachache, irritability, and a sad feeling with weepiness at times. If these side effects do not clear up in a week, bring the problem to the attention of the prescriber. But don't give up and stop treatment if they occur.
3. Rebound events. Less common are rebound events. These occur as the medication wears off and comes out of the system. One type is irritability or even explosiveness. Another is sadness or a down feeling. These side effects generally last thirty to forty five minutes and are gone. Changes in mediation can often remove or reduce the problem.
Let me give you an example of a rebound event and how it was handled. Al's ADD was under good control with medication, but when the morning dose wore off at about 5pm he became irritable, unpleasant and angry. We corrected this by adding a short acting form before the medication wore off. This slowed the speed that the medication left the body and the problem stopped.
4. Tics. A very infrequent side effect is tics. These are involuntary motor movements such as blinking, coughing or jerking of the arms. While this is more likely to happen to someone with a familial tic disorder, it can happen to anyone on stimulants. These tics will disappear after the medication is discontinued, but it may take several weeks for them to be completely gone.
It is not always necessary to stop the medication if a tic occurs. Often the tic does not bother anyone. I don't stop the medication unless the child is upset or is being teased by other children. In addition, there are medications that may control or remove the tics.
5. Rare Side Effects. Now let's get really rare. I have had two cases of hair loss, one with Adderall and the other with Wellbutrin. Another is a chronic dry mouth and I only include it because this was mentioned by Tim Wilens, M.D. of Harvard in an ADD presentation. Neither I nor my dental consultant is aware of seeing a dry mouth from stimulants. But I think it is something to keep in mind if there is a feeling of dryness in the mouth or a good deal of tooth trouble.
One more point. If a child or adolescent complains about the medication he is taking, listen and consider it a probable side effect. For a more complete discussion you can check out "When Kids Refuse Medication" in my NewsNote Library at simonepstein.org.
No list can cover all the possible side effects or parental concerns. If there is a side effect please consult your doctor.
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