Significant weight loss, Continue medication & Refer to GP usual Psychiatry Team Anorexia Mania/hypomania Stop mediation & Refer to GP usual Psychiatry Team Cardiac arrhythmias (e.g. Stop mediation & Refer to GP usual Psychiatry Team QT prolongation) Rash and allergic reactions Stop mediation & Refer to GP usual Psychiatry Team Serotonin syndrome or Stop mediation & Refer to GP usual Psychiatry Team neuroleptic malignant syndrome-like events Restlessness or agitation Stop mediation & Refer to GP Specialist Team The patient should be advised to report any of the following signs or symptoms to their GP without delay: Restlessness or agitation, Suicidal behaviour, self-harm, or hostility Drowsiness, confusion, or convulsions Other important co morbidities (e.g. Chickenpox exposure). Include advice on management and prevention and who will be responsible for this in each case: ADHD, ASD, Tourette syndrome, Anxiety disorders Any adverse reaction to a black triangle drug or serious reaction to an established drug should be reported to the MHRA via the “Yellow Card” scheme. 9.Baseline List of investigations / monitoring undertaken by secondary care investigations The use of antidepressants has been linked with suicidal thoughts and behaviour; children, young adults, and patients with a history of suicidal behaviour are particularly at risk. Parents/ carers should be specifically warned about this risk, and this should be recorded in the notes. Where necessary patients should be monitored for suicidal behaviour, or hostility, particularly at the beginning of treatment or if the dose is changed. Specific arrangements must be made for careful monitoring of adverse drug reactions, as well as for reviewing mental state and general progress; for example, weekly contact with the child or young person and their parent(s) or carer(s) for the first 4 weeks of treatment. The precise frequency will need to be decided on an individual basis by secondary care, and recorded in the notes. 10. Ongoing Is monitoring required? No specific monitoring is required as specialist monitoring CAMHS services will continue to monitor for adverse requirements to be drug reactions, mental state and general progress at undertaken by GP appropriate intervals. 11. No special considerations. Pharmaceutical aspects
Significant weight loss, Anorexia Continue medication & Refer to usual Psychiatry Team GP Mania/hypomania Stop mediation & Refer to usual Psychiatry Team GP Cardiac arrhythmias (e.g. QT prolongation) Stop mediation & Refer to usual Psychiatry Team GP Rash and allergic reactions Stop mediation & Refer to usual Psychiatry Team GP Serotonin syndrome or neuroleptic malignant syndrome-like events Stop mediation & Refer to usual Psychiatry Team GP Restlessness or agitation Stop mediation & Refer to Specialist Team GP The patient should be advised to report any of the following signs or symptoms to their GP without delay: Restlessness or agitation, Suicidal behaviour, self-harm, or hostility Drowsiness, confusion, or convulsions Other important co morbidities (e.g. Chickenpox exposure). Include advice on management and prevention and who will be responsible for this in each case: ADHD, ASD, Tourette syndrome, Anxiety disorders Any adverse reaction to a black triangle drug or serious reaction to an established drug should be reported to the MHRA via the “Yellow Card” scheme. 9.Baseline investigations List of investigations / monitoring undertaken by secondary care The use of antidepressants has been linked with suicidal thoughts and behaviour; children, young adults, and patients with a history of suicidal behaviour are particularly at risk. Parents/ carers should be specifically warned about this risk, and this should be recorded in the notes. Where necessary patients should be monitored for suicidal behaviour, or hostility, particularly at the beginning of treatment or if the dose is changed. Specific arrangements must be made for careful monitoring of adverse drug reactions, as well as for reviewing mental state and general progress; for example, weekly contact with the child or young person and their parent(s) or carer(s) for the first 4 weeks of treatment. The precise frequency will need to be decided on an individual basis by secondary care, and recorded in the notes. 10. Ongoing monitoring requirements to be undertaken by GP Is monitoring required? No specific monitoring is required as specialist CAMHS services will continue to monitor for adverse drug reactions, mental state and general progress at appropriate intervals. 11. Pharmaceutical aspects No special considerations.
GMMMG-SCP-SSRIs-for-depression-in-children-and-adolescents-GMMMG-approved-15-10-2015-v1-1.docx