Psychiatric Pharmacy Essentials: Child and Adolescent Psychiatry

Children and adolescents are not “miniature adults.” The safe and effective use of pharmacotherapy in pediatric populations requires attention to developmental changes, as well as an appreciation for the differential presentation of mental illnesses relative to adults.

Essential Questions

  • What do I need to know about developmental pharmacology?1-2
  • How might the disposition of psychotropic drug levels differ in pediatric populations?3
  • What is the effectiveness and safety of antipsychotics4-5 and antidepressants6-8 in pediatric populations?
  • What is the evidence for pharmacologic treatments for bipolar disorder in pediatric populations?9-11
  • What is the evidence for pharmacotherapy and/or cognitive behavioral therapy for managing obsessive compulsive disorder in pediatric populations?12-14
  • What is the evidence for combination pharmacotherapy and cognitive behavioral therapy for managing SSRI-resistant major depressive disorder in pediatric patients?15-17
  • What is the evidence for pharmacologic treatments for substance use disorders in pediatric populations?18-19

Reviewer 1:  Miranda Johnson, PharmD, BCPP
Reviewer 2: Danielle Dauchot, PharmD, BCPP
2026-2027 AAPP Resident and New Practitioner Committee

References
  1. Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental Pharmacology — Drug Disposition, Action, and Therapy in Infants and Children. N Engl J Med. 2003 Sep 18;349(12):1157-1167. Massachusetts Medical Society. DOI: 10.1056/nejmra035092.
  2. Smits A, Annaert P, Cavallaro G, De Cock PAJG, de Wildt SN, Kindblom JM, et al. Current knowledge, challenges and innovations in developmental pharmacology: A combined conect4children Expert Group and European Society for Developmental, Perinatal and Paediatric Pharmacology White Paper. Brit J Clin Pharma. 2022 Dec;88(12):4965-4984. Wiley. DOI: 10.1111/bcp.14958.
  3. Fekete S, Hiemke C, Gerlach M. Dose-Related Concentrations of Neuroactive/Psychoactive Drugs Expected in Blood of Children and Adolescents. Therapeutic Drug Monitoring. 2020 Apr;42(2):315-324. Ovid Technologies (Wolters Kluwer Health). DOI: 10.1097/ftd.0000000000000685.
  4. Pillay, B.Sc. J, Boylan, M.D., Ph.D., FRCPC K, Carrey, FRCPC N. First- and Second-Generation Antipsychotics in Children and Young Adults: Systematic Review Update. Agency for Healthcare Research and Quality (AHRQ); 2017 Mar 16. DOI: 10.23970/ahrqepccer184.
  5. Pillay J, Boylan K, Newton A, Hartling L, Vandermeer B, Nuspl M, et al. Harms of Antipsychotics in Children and Young Adults: A Systematic Review Update. Can J Psychiatry. 2018 Oct;63(10):661-678. SAGE Publications. DOI: 10.1177/0706743718779950.
  6. Strawn JR, Mills JA, Poweleit EA, Ramsey LB, Croarkin PE. Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents. Pharmacotherapy. 2023 Jul;43(7):675-690. Wiley. DOI: 10.1002/phar.2767.
  7. Hetrick SE, McKenzie JE, Bailey AP, Sharma V, Moller CI, Badcock PB, et al. New generation antidepressants for depression in children and adolescents: a network meta-analysis.. Cochrane Database Syst Rev. 2021 May 24;5(5):CD013674. DOI: 10.1002/14651858.CD013674.pub2; PubMed PMID: 34029378; PubMed Central PMCID: PMC8143444.
  8. Zhou X, Teng T, Zhang Y, Del Giovane C, Furukawa TA, Weisz JR, et al. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. Lancet Psychiatry. 2020 Jul;7(7):581-601. Elsevier BV. DOI: 10.1016/s2215-0366(20)30137-1.
  9. Wozniak J, O’Connor H, Iorini M, Ambrose AJH. Pediatric Bipolar Disorder: Challenges in Diagnosis and Treatment. Pediatr Drugs. 2025 Mar;27(2):125-142. Springer Science and Business Media LLC. DOI: 10.1007/s40272-024-00669-z.
  10. Vita G, Nöhles VB, Ostuzzi G, Barbui C, Tedeschi F, Heuer FH, et al. Systematic Review and Network Meta-Analysis: Efficacy and Safety of Antipsychotics vs Antiepileptics or Lithium for Acute Mania in Children and Adolescents. J Am Acad Child & Adolesc Psychiatry. 2025 Feb;64(2):143-157. Elsevier BV. DOI: 10.1016/j.jaac.2024.07.920.
  11. Yee CS, Hawken ER, Baldessarini RJ, Vázquez GH. Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses. International Journal of Neuropsychopharmacology. 2019 Aug 1;22(8):531-540. Oxford University Press (OUP). DOI: 10.1093/ijnp/pyz034.
  12. Ivarsson T, Skarphedinsson G, Kornør H, Axelsdottir B, Biedilæ S, Heyman I, et al. The place of and evidence for serotonin reuptake inhibitors (SRIs) for obsessive compulsive disorder (OCD) in children and adolescents: Views based on a systematic review and meta-analysis. Psychiatry Res. 2015 May;227(1):93-103. Elsevier BV. DOI: 10.1016/j.psychres.2015.01.015.
  13. Steele DW, Kanaan G, Caputo EL, Freeman JB, Brannan EH, Balk EM, et al. Treatment of Obsessive-Compulsive Disorder in Children and Youth: A Meta-Analysis. Pediatrics. 2025 Mar 1;155(3). American Academy of Pediatrics (AAP). DOI: 10.1542/peds.2024-068992.
  14. Uhre CF, Uhre VF, Lønfeldt NN, Pretzmann L, Vangkilde S, Plessen KJ, et al. Systematic Review and Meta-Analysis: Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Children and Adolescents. J Am Acad Child & Adolesc Psychiatry. 2020 Jan;59(1):64-77. Elsevier BV. DOI: 10.1016/j.jaac.2019.08.480.
  15. Brent D, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller M, et al. Switching to Another SSRI or to Venlafaxine With or Without Cognitive Behavioral Therapy for Adolescents With SSRI-Resistant Depression. JAMA. 2008 Feb 27;299(8):901. American Medical Association (AMA). DOI: 10.1001/jama.299.8.901.
  16. Vitiello B, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller MB, et al. Long-Term Outcome of Adolescent Depression Initially Resistant to Selective Serotonin Reuptake Inhibitor Treatment. J Clin Psychiatry. 2011 Mar 15;72(03):388-396. Physicians Postgraduate Press, Inc. DOI: 10.4088/jcp.09m05885blu.
  17. Dwyer JB, Stringaris A, Brent DA, Bloch MH. Annual Research Review: Defining and treating pediatric treatment‐resistant depression. Child Psychology Psychiatry. 2020 Mar;61(3):312-332. Wiley. DOI: 10.1111/jcpp.13202.
  18. Squeglia LM, Fadus MC, McClure EA, Tomko RL, Gray KM. Pharmacological Treatment of Youth Substance Use Disorders. J Child Adolesc Psychopharmacol. 2019 Aug 1;29(7):559-572. SAGE Publications. DOI: 10.1089/cap.2019.0009.
  19. Rockhill CM, Ramtekkar U, Becker TD, Greenhill L, Hayek M, Vasa RA, et al. Clinical Practice Guideline: Assessment and Treatment of Adolescents and Young Adults With Substance Use Disorders and Problematic Substance Use (Excluding Tobacco). J Am Acad Child & Adolesc Psychiatry. 2026 Feb;65(2):105-138. Elsevier BV. DOI: 10.1016/j.jaac.2025.08.006.