BNF for Children 2011-2012

BNFC 2011–2012 4.3 Antidepressant drugs 183Indication and doseTreatment and prophylaxis of mania, bipolardisorder, recurrent depression (see also notesabove), aggressive or self-mutilating behaviour. By mouthSee under preparations below, adjusted to achievea serum-lithium concentration of 0.6–1 mmol/litre12 hours after a dose on days 4–7 of treatment,then every week until dosage has remained constantfor 4 weeks and every 3 months thereafter;doses are initially divided throughout the day, butonce daily administration is preferred whenserum-lithium concentration stabilisedNote Preparations vary widely in bioavailability;changing the preparation requires the same precautionsas initiation of treatmentCamcolit c (Norgine) ACamcolit 250 c tablets, f/c, scored, lithium carbonate250 mg (Li + 6.8 mmol), net price 100-tab pack =£3.09 Label: 10, lithium card, counselling, see aboveCamcolit 400 c tablets, m/r, f/c, scored, lithiumcarbonate 400 mg (Li + 10.8 mmol), net price 100-tabpack = £4.13. Label: 10, lithium card, 25, counselling,see aboveDoseTreatment. By mouth(see above for advice on bioavailability and serum-lithiummonitoring)Child 12–18 years initially 1–1.5 g dailyProphylaxis. By mouth(see above for advice on bioavailability and serum-lithiummonitoring)Child 12–18 years initially 300–400 mg dailyLiskonum c (GSK) ATablets, m/r, f/c, scored, lithium carbonate 450 mg(Li + 12.2 mmol), net price 60-tab pack = £2.88.Label: 10, lithium card, 25, counselling, see aboveDoseTreatment. By mouth(see above for advice on bioavailability and serum-lithiummonitoring)Child 12–18 years initially 225–675 mg twice dailyProphylaxis. By mouth(see above for advice on bioavailability and serum-lithiummonitoring)Child 12–18 years initially 225–450 mg twice dailyLITHIUM CITRATECautions see under Lithium Carbonate and notesaboveCounselling Patients should maintain an adequate fluidintake and should avoid dietary changes which might reduceor increase sodium intake; lithium treatment cards areavailable from pharmacies (see above)Side-effects see under Lithium Carbonate and notesaboveLicensed use not licensed for use in childrenIndication and doseSee under Lithium Carbonate and notes above. By mouthAdjust to achieve serum-lithium concentration of0.6–1 mmol/litre as described under LithiumCarbonate aboveNote Preparations vary widely in bioavailability;changing the preparation requires the same precautionsas initiation of treatmentLi-Liquid c (Rosemont) AOral solution, lithium citrate 509 mg/5 mL (Li +5.4 mmol/5 mL), yellow, net price 150-mL pack =£5.79; 1.018 g/5 mL (Li + 10.8 mmol/5 mL), orange,150-mL pack = £11.58. Label: 10, lithium card,counselling, see aboveNote 5-mL dose of 509 mg/5 mL oral solution is equivalentto 200 mg lithium carbonatePriadel c (Sanofi-Aventis) ALiquid, sugar-free, lithium citrate 520 mg/5 mL(approx. Li + 5.4 mmol/5 mL), net price 150-mL pack= £5.61. Label: 10, lithium card, counselling, seeaboveNote 5-mL dose is equivalent to 204 mg lithium carbonate4.3 Antidepressant drugs4.3.1 Tricyclic antidepressant drugs4.3.2 Monoamine-oxidase inhibitors4.3.3 Selective serotonin re-uptakeinhibitors4.3.4 Other antidepressant drugsDepression in children should be managed by anappropriate specialist and treatment should involvepsychological therapy.The major classes of antidepressant drugs include thetricyclics and related antidepressant drugs (section4.3.1), the selective serotonin re-uptake inhibitors(SSRIs) (section 4.3.3), and the monoamine oxidaseinhibitors (MAOIs).Antidepressant drugs should not be used routinely inmild depression, and psychological therapy should beconsidered initially; however, a trial of antidepressanttherapy may be considered in cases refractory to psychologicaltreatments or in those associated with psychosocialor medical problems. Drug treatment of milddepression may also be considered in children with ahistory of moderate or severe depression.Choice of antidepressant drug should be based on theindividual child’s requirements, including the presenceof concomitant disease, existing therapy, suicide risk,and previous response to antidepressant therapy.When drug treatment of depression is considerednecessary in children, the SSRIs should be consideredfirst-line treatment; following a safety and efficacyreview, fluoxetine is licensed to treat depression inchildren.4 Central nervous system