‘Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness’ recommends that patients at risk of suicide, including all patients with a recent history of self-harm, who are treated with psychotropic drugs should receive modern, less toxic drugs and/or supplies lasting no more than 2 weeks.
NICE Clinical Guideline on ADHD (Sept 2008) advises:
Drug treatment for children and young people with ADHD should always form part of a comprehensive treatment plan that includes psychological, behavioural and educational advice and interventions. When a decision has been made to treat children or young people with ADHD with drugs, healthcare professionals should consider:
Drug treatment for adults with ADHD should always form part of a comprehensive treatment programme that addresses psychological, behavioural and educational or occupational needs.
Following a decision to start drug treatment in adults with ADHD, methylphenidate should normally be tried first.
MHRA Drug Safety Update (Mar 2009) advises:
The benefits of methylphenidate continue to outweigh the risks when used to treat ADHD in children aged 6 years or older and adolescents. Treatment must be under the supervision of a specialist in childhood behavioural disorders. Patients should be monitored during treatment, which should be interrupted at least once a year to determine whether continuation is needed.
More detailed advice includes contraindications to methylphenidate, pretreatment screening and ongoing monitoring.
Under ongoing monitoring, the following is advised:
Atomoxetine is associated with treatmentemergent psychotic or manic symptoms in children and adolescents without a history of such disorders. If such symptoms occur, consideration should be given to a possible causal role of atomoxetine and discontinuation of treatment.