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BNSSG Paediatric Joint Formulary

4.2 Mental health disorders

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Last edited: 24-09-2024

4.2.1 Attention deficit hyperactivity disorder

First line drugs

Second line drugs

Specialist drugs

Secondary care

There are supply disruptions affecting a wide range of medicines used in the treatment of attention deficit hyperactivity disorder (ADHD). The medicines supply notification is available here. Local guidance has also been published to support clinicians with these supply disruptions and patient reviews and is available here. Please also refer to a BNSSG Patient Information Leaflet about methylphenidate

NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management

Specific indications: ADHD

Methylphenidate immediate-release & modified-release (TLS Amber 3 months) SCP here

Atomoxetine (TLS Amber 3 months) SCP here

Lisdexamfetamine (TLS Amber 3 months) SCP here

Guanfacine modified-release tablets (TLS Amber 3 months)

For treatment of ADHD in children and adolescents in line with the SCP

4.2.2 Bipolar disorder and mania

Aripiprazole (oral) (TLS Red)

NICE TA292 Aripiprazole for the treatment of moderate to severe manic episodes in adolescents aged 13 and older with bipolar 1 disorder.
For Schizophrenia see below

4.2.3 Depression

Selective Serotonin Re-uptake Inhibitors (SSRIs)

NICE QS48 Depression in children and young people

SSRIs may initially increase anxiety levels and it may be necessary to ‘cover’ their initiation with a brief course of a benzodiazepine in order to encourage compliance
Abrupt withdrawal of SSRIs should be avoided (associated with headache, nausea, paraesthesia, dizziness and anxiety)
Withdrawal syndrome is reported to the CSM more commonly with paroxetine than with other SSRIs
There is an increased risk of bleeding in high risk patients including GI bleed with SSRIs especially if prescribed with aspirin and NSAIDs - consider GI protection with PPI if on combination or if elderly

Fluoxetine (TLS Amber Specialist Recommended)

Citalopram (TLS Amber Specialist Recommended)

Sertraline (TLS Amber Specialist Recommended)

First line for obsessive-compulsive disorder

Fluvoxamine (TLS Amber)

In young adults (and children) for the treatment of obsessive compulsive disorder, depressive disorder and anxiety disorder

Tricyclic and Related Antidepressant Drugs

Amitriptyline (TLS Amber)

4.2.4 Psychoses and schizophrenia

NICE CG155 Psychosis and schizophrenia in children and young people: recognition and management
NICE QS102
Bipolar disorder, psychosis and schizophrenia in children and young people moderate to severe manic episodes in adolescents (13 years and older) with bipolar 1 disorder see NICE TA292

Olanzapine (TLS Red)

Amisulpride (TLS Red)

Quetiapine (TLS Red)

Clozapine (TLS Red)

Licensed for treatment resistant schizophrenia and prescribed under the supervision of a consultant psychiatrist
Clozapine is restricted to patients who have not responded to two or more antipsychotics (one of which should be an atypical antipsychotic), or who are intolerant of conventional antipsychotics
Clozapine may only be initiated by senior medical staff working in psychiatry, or neurology, who are registered with a clozapine patient monitoring service
Full blood counts are required prior to and during clozapine treatment

Aripiprazole (oral) (TLS Amber 3 months)

For schizophrenia/psychosis and control of associated agitation and disturbed behaviour in adolescents aged 15 years and older. See NICE TA213 Aripiprazole for schizophrenia in people aged 15-17 years
See shared care protocol here
Non-formulary for schizophrenia for children under 15 years
For bipolar see above