• Collaborative

Managing psychiatric medication for children during the confinement period

Dr Pierre Ellul & Dr Benjamin Landman, Child Psychiatrists. Excellence Center for Neurodevelopmental Disorders - Robert Debré Hospital, Paris – France

Here, you will find advice on the use of psychiatric medication for your child during the confinement period.

My child tells me that he/she feels better during the confinement period and that he/she no longer needs to take his/her treatment:

# It is quite normal that your child questions his/her daily medication, especially during this confinement period. Many patients are feeling better when they stay at home. Moreover, during a stressful period (for example the November 2015 Paris attacks), many patients experienced an improvement of their psychiatric condition (this improvement was only transitory).

# Don’t stop medication during the confinement period without your doctor’s approval. Any discontinuation of psychiatric medication may worsen the psychiatric condition of your child. Indeed, several psychiatric medications present risks of withdrawal and therefore require a gradual dose decrease with medical supervision. As the healthcare system is saturated by patients infected by the COVID-19, your child may not receive the appropriate psychiatric care if his/her psychiatric disorder worsens.

Should I let my child treat him/herself on his/her own?

# During the confinement period, it is imperative that you supervise you child’s treatment and provide them with the medication. Your child's stress level may increase due to the COVID-19 pandemic, and he/she may experience suicidal thoughts. Medications should generally be kept in a secure place that is not accessible to children. Moreover, it is essential to ensure compliance with treatment schedule and dosages.

My child is sleeping in the morning and goes to bed very late, should I change the treatment schedule?

# During confinement period, it is important to keep a regular and healthy lifestyle. In this context, medication must be taken at a fixed time as prescribed by your doctor. It is critical that you follow the instructions provided by your doctor. Small variations in treatment schedule are acceptable, but don’t forget to take a dose.

# Several psychiatric medications modify one’s quality of sleep or wakefulness. It is therefore important to precisely follow treatment schedule.

# To help you follow the treatment schedule, you can create a pill card (a visual way to show all medication), put an alarm on your phone or even buy a weekly pill box at the pharmacy.

My prescription ends soon: What should I do?

# Since March 2020, pharmacists can exceptionally renew prescriptions until the 31st of May 2020. If necessary, your child psychiatrist (or general practitioner or pediatrician) can send you a prescription by email which will be accepted by pharmacists.

Methylphenidate (French trade names: Ritaline®, Concerta®, Medikinet®, Quasym®)

# It is recommended to continue treatment with methylphenidate at the usual dose for your child. For example, if your child usually takes 20 mg of Ritalin LP in the morning, it is strongly advised not to give the medication at noon. Delaying the dose may lead to insomnia.

# The pharmacy will be able to renew your prescription if you provide a written agreement from the child psychiatrist (or general practitioner or pediatrician).

My child was prescribed a blood test by his doctor to monitor his/her treatment, but I am afraid to take him/her to the medical clinic.

# It is critical that you follow the instructions provided by your doctor and go for a blood test. You should not be afraid. Make sure that the medical clinic is open and respect the social distancing measures.

Clozapine (LEPONEX) medication involves weekly/monthly blood tests to check the status of white blood cells. If you cannot leave house, your doctor can arrange for a nurse to visit you at home and take a blood sample from your child.

What should I do with my child's treatment if my child has a fever or is suspected of a COVID-19 infection?

# If your child is taking neuroleptics, such as tercian (Cyamemazine®), risperidone (Risperdal®), quetiapine (Xeroquel®), aripiprazole (Abilify®) or loxapine (Loxapac®, and develops a fever, you should contact your doctor immediately. If you cannot reach your doctor, go to the nearest pediatric emergency room. You can also call the 15. Do not stop treatment without your doctor’s approval.

# If your child takes lithium (Théralithe®): If the fever gets higher than 39°C or if your child experiences vomiting or diarrhea: stop lithium during 24 to 48 hours and contact your doctor to carry out a lithiemia.

# If your child is taking a serotonergic antidepressant such as fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Deroxat®) or escitalopram (Seroplex®), do not stop treatment. There is no risk of an interaction between these drugs and the COVID-19 infection.

# If your child is taking anxiolytics or hypnotics, such as temesta (Lorazepam®), valium (Diazepam®), bromazepam (Lexomil®), alprazolam (Xanax®), hydroxyzin (Atarax®) or alimemazine (Theralene®), there is no risk of an interaction between these drugs and COVID19 infection.

As a reminder, all anti-inflammatory drugs are strictly prohibited. Only paracetamol is authorized in case of fever.

If your child is infected by the COVID-19, do not forget to inform all doctors that he/she is taking psychotropic drugs.

48 Boulevard Serurier, 75019  Paris France

©2020 by Dr. Benjamin Landman. Child Psychiatry, Robert Debre Hospital - Paris