Over the last decade, several published studies have reported an increased risk of type 2 diabetes associated with antidepressant use in adults. But does the same hold true for children and adolescents?

Tourette’s disorder (TD) is a movement disorder emerging during childhood that causes persistent motor and vocal tics. TD is treated with a variety of medications, but often with an off-label designation.

Since the 2004 FDA black-box warning on all antidepressants for pediatric use, controversy continues over the use of SSRIs and SNRIs in children and adolescents. Both classes of medication are still commonly used for pediatric depressive disorders, anxiety disorders, and obsessive-compulsive disorder.

Discussing medications with adolescents can be challenging. Because there is so much variation in family structure and the problems that kids and families face, it’s important to maintain some flexibility in how clinicians evaluate adolescents.

In this interview, Dr. Shatkin talks about how the adolescent brain works, and how we can use this understanding to work more effectively in our practices with both adolescents and their parents. There’s a misconception that dopamine equates to pleasure. It’s not pleasure; it’s the promise of pleasure. Dopamine is the idea that something great might happen. And so high dopamine levels drive kids into high-risk situations with high amounts of potential pleasure. This is aggravated by the fact that the frontal cortical areas are not well myelinated yet and not well connected to the limbic system. So, when kids are younger, they have less control over those impulsive drives.

Some studies have indicated that patients with ADHD may be at an increased risk of suicide. While these studies have shown associations between methylphenidate use and suicide, it is not clear whether the stimulant actually causes suicidality or whether patients taking stimulants are suicidal for other reasons.

Integrative approaches to treating ADHD have become increasingly sought after by parents, especially those who are concerned about the side effects and potential overuse of psychostimulant medication.

Our official 2017 Carlat ADHD Stimulant Comparison table, an easy-to- use reference that you’ll find handy.

We all hear that the problem is that every child with bad behavior is given a stimulant. In actuality, the saddest cases are the children who have not been identified despite chronic academic underperformance and behavioral problems.

Modafinil (Provigil) is FDA-approved for narcolepsy, obstructive sleep apnea, and shift work sleep disorder, but not for ADHD. Given that it has some of the same stimulating properties of psychostimulants, it should theoretically be effective.