Monitoring, maintenance, and discontinuation

Plans for monitoring a child taking psychotropic medication should be in place from the outset and tailored to the regimen and stage of therapy. More frequent visits will be required initially, particularly when the dosage must be titrated gradually or significant early-onset side effects are likely.

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Longer intervals between visits are generally appropriate during maintenance. However, drugs whose adverse effects may be gradual (e.g., altered growth trajectory with stimulants, glucose dysregulation and weight gain with antipsychotics) require regular monitoring, and children should be seen more often when psychosocial stress or adherence issues are prominent.

The possibility of discontinuation usually arises when apparent recovery suggests that a medication is no longer necessary or side effects become overly burdensome. Gradual tapering is essential for some agents (e.g., SSRIs, benzodiazepines) and generally advisable.

More frequent visits are customary around the time of discontinuation to monitor for withdrawal, rebound symptoms, and relapse. Data to guide the length of follow-up after discontinuation are relatively sparse, although six months to one year is reasonable for conditions with a high rate of recurrence, such as mood and anxiety disorders, with additional visits at times of heightened stress or vulnerability, the authors say.  

The Practice Parameter on the Use of Psychotropic Medication in Children and Adolescents was published in Journal of the American Academy of Child and Adolescent Psychiatry (2009;48:961-967). .

Mr. Sherman is a freelance medical writer in New York City.