History of Psychological Treatments

psychosurgery

The treatment of mental illness has developed throughout the years, performing some of the most dangerous acts upon society’s most vulnerable people. This time-line covers the most widespread psychological treatments throughout history, from the lobotomy and electro convulsive therapy to rotation therapy and the ingestion of pharmaceutical drugs.

Early 1800s: Rotation Therapy - The Swing

Inspired initially from the grandfather of Charles Darwin, Erasmus Darwin, there were two main methods of implementing theThe Swing swing in psychiatric hospitals.

  1. An ordinary chair, suspended from the ceiling, with ropes attached to the legs. The ropes were used to spin the chair until it was set in motion.
  2. A pole fixed from the floor to the ceiling by iron rods. It had a horizontal arm attached, which was used to hang a chair or bed and to spin the patient.

Both methods procured the same results: the patients were spun in a circular motion until they promised to obey the doctors orders and get better. The doctors would release them from the chair/ bed and allow them time to sleep and recover. However, when the nausea and shock had worn off, the patients were still mentally ill, forcing another session on the swing and therefore repeating the process.

Known side effects:

  • Anxiety
  • Bowel movement
  • Fear
  • Nausea
  • Paleness
  • Vertigo
  • Vomiting
  • The powerful shock to the disposition subdued even the most refractory patients. Further results were tiredness, and a deep sleep, which often lasts for many hours.

Doctors at this time, such as Dr Joseph Mason Cox and Dr. Horn strongly believed in the treatment’s positive effects, disregarding the physical and emotional trauma associated with it:

“I have the pleasure of knowing that he continues well, and I am confident owes his life and reason to the swing.” – Dr Joseph Mason Cox 

1800-1850: Moral Therapy

Moral therapy emerged in the treatment of mental illnesses in the late 1700s, and became prominent in asylums across the world by the 1800s.

One of the first pioneers of the treatment regime was a Quaker in England named William Tuke. Following the death of a fellowWilliam Tuke Guts and Gore quaker in an asylum in 1790, Tuke established an asylum which functioned like no other of that period. In 1796, the York Retreat was opened and 30 mentally ill patients were admitted, where they lived as a part of a small community in a large country house.

The treatment regime consisted of some light manual work, talking and socialising ,and a great deal of rest. Mechanical restraints were seldom used, and the aim of the asylum was to focus on cultivating rationality and moral strength, as opposed to containing those who were deemed ‘dangerous’ or ‘mad.’ Tuke moved his family into the institution, and the entire family became known as the founders of moral treatment. They created a family style ethos, where the patients were given chores to perform through the day and spent most evenings as leisure time. It gave the institution a sense of normality, instead of feeling like a prison, making the patients feel at home.

Moral therapy was based on the patients’ cure and rehabilitation back into society, and because of this, many patients spent only short periods of time in the institution. There were many success stories linked to moral treatment. Patients were recovering and adapting back into their home environment well, and the reputation of this new treatment magnified.

The York Retreat guts and Gore

It was Benjamin Rush who initially began the widespread use of moral treatment in 1792 in the United States. As a physician, he was hired to work at the Pennsylvania Hospital, where he was confronted with terrible conditions. He was appalled at the neglect dealt to the mentally ill patients, and campaigned to the state to build a separate mental ward. It was here where he began the basic practice of moral treatment. Rush demanded that all staff in the hospital needed to be intelligent and sensitive, who would work closely with the patients. The doctors read to patients, talked to them and took them on regular walks around the grounds of the hospital.

Rush is considered to be the father of American psychiatry, and became renowned in his field when he published his bookTranquiliser Chair Guts and Gore Medical Inquiries and Observations upon the Diseases of the Mind. It was the first psychiatry test book, and defined many different forms of mental illnesses with individual treatment plans. Rush explained in his book that he believed most forms of mental illness to be the direct cause of disruptions of the blood circulation, or by sensory overload. He treated them with methods he believed to improve circulation to the brain, such as a centrifugal spinning board, and the ‘tranquillizer chair.’ The chair was designed as a sensory deprivation tool, where the patient would be restrained and a ‘sensory deprivation head enclosure’ would be set in place. He also practised other methods of treatment, such as blood-letting (bleeding), purging, and hot and cold baths.

Moral treatment became mainstream in America around 1841 when Boston school teacher, Dorothea Dix, became aware of terrible prison conditions, and the mental patients who were confined there. She spent a year in England with Samuel Tuke, and travelled around the US trying to improve conditions and gain government funding for mental institutions. She was as strong advocate for the use of moral treatment, and succeeded in personally establishing 32 state hospitals with humane conditions.

Dorothea Dix Guts and Gore

Despite the apparent glowing reports regarding moral treatment, there were many current and former patients who spoke out against it. The Alleged Lunatics’ Friend Society, an advocate group made from ex patients, claimed that moral treatment was a form of social repression, where patients were ‘re-educated’ and treat as though they were children. Patients were not entitled to discuss their care with the staff at the asylums, and many of them were unaware of their legal rights.

The Decline of Moral Treatment

By the 1830s, the asylums were becoming severely overcrowded and understaffed. Gradually, the emphasis of the asylums diverted from patients’ care and treatment, to financial gain and security. The asylums grew into disrepair, and their decoration was compromised to pay for higher walls and physical restraints. Very little time was spent practising moral treatment, and the asylums reverted back to ‘warehousing’ those deemed insane. The concept of moral treatment was not lost forever, and can be seen echoed in the modern occupational therapy.

Early 1900s: Hydrotherapy

Hydrotherapy became a popular form of psychological treatment at the beginning of the 20th century and was used for several decades before hospital overcrowding became a serious problem.

Inspired from the old German spa therapies, Hydrotherapy was deemed to be an effective form of treatment for a variety of mental disorders, including anxiety, insomnia, depression and aggression. Hot or warm water was used to calm and relax patients, whilst cold water was used on hyperactive patients as it slowed the blood flow to the brain and decreased activity.

Hydrotherapy predominantly consisted of a bath tub covered by a thick canvas to maintain the temperature of the water. This canvas had room for the head to stick out from, plus patients could be allowed their arms outside it at meal times. Attendants would monitor the water before and during the patients sessions, ensuring the prescribed temperature was kept to at all times. The length of the session depended on the mental condition of the patients, and ranged from a few hours to several days. Many patients found this form of therapy extremely constricting, and particularly cruel, especially when cold water was applied.

Hydrotherapy

Cold sprays were also used on patients, although it was found to not be as effective and fast working as the bath method. Patients would be sprayed with cold water, much like a shower to decrease their motor activity and subdue them somewhat. Packs were also used, and they consisted of several sheets being submerged in the appropriate water temperature and then wrapped around the patients for as long as prescribed. There are some examples of doctors using high powered water jets at their patients; they are blasted down with hot or cold water for as long as deemed necessary.

As over crowing took told of the psychiatric institutions, Hydrotherapy became gradually phased out. It consumed too much time, resources and money to be classed as a viable option and cheaper, quicker methods became urgently needed.

1934: Chemically Induced Seizures

Ladislaus von Meduna, a Hungarian pathologist, came to the conclusion that there was a distinctLadislaus von Meduna correlation between epileptics and schizophrenics. He discovered that schizophrenia was quite rare in patients suffering from epilepsy and derived the hypothesis that it was seizures which prevented the mental disorder. This was further supported by the notion that epileptic patients often felt a sense of euphoria after a seizure, indicating the same affect would be felt be a schizophrenic after a seizure also.

Whilst this link between the illnesses is prominent, the methods used by von Meduna were questionable and deemed by today’s standards as dangerous. Patients were given an array of seizure-inducing drugs, such as absinthe, caffeine and strychnine, but none of these produced the desired effect. Finally, Metrazol was selected as the drug of choice, and given to patients for several decades. Whilst von Meduna argued that many of his patients were cured by this form of treatment, his critics saw a trail of patients who were left with broken bones and distorted memories. It was for this reason that the treatment eventually died out, as both doctors and patients agreed that the risks far outweighed the benefits. 

1935: Lobotomy (Leucotomy)

The lobotomy was first performed in 1935 by a Portuguese neurologist named Egas Moniz. He believed that patients with obsessive behavioural traits were suffering from fixed circuits in the brain. He believed that severing the connecting fibres of the neurons activity would eliminate the vast proportion of mental disorders, and conducted a procedure that consisted of:

Drilling two holes in the patient’s skull, either at the top or at the side. A sharp tool known as a leuctome would be forced through the holes and into the brain, where it would be swept from left to right, ensuring the connections between the frontal lobe and the rest of the brain were severed.

Moniz reported that the first 20 patients of the lobotomy displayed significant improvements, and encouraged other doctors to witness his success. Walter Freeman, an American neurologist, became an advocate of the Lobotomy after an encounter with Moniz, and took the procedure back with him to the US where it quickly became a mainstream form of treatment by 1936. As the procedure was limited by the need of a neurosurgeon, Freeman adapted it so it could be performed by regular doctors, allowing it to become more accessible to those in need.

The new and simplified version of the lobotomy was known as the ‘transorbital’ lobotomy and involvedLobotomy
lifting the upper eyelid and placing a leucotome against the top corner of the eye socket. Using a mallet, the leucotome was then hammered in through the bone and into the brain. The surgical instrument was then moved around inside the skull, ensuring the brain tissue was cut. This would be repeated on the other side of the head also.

The Lobotomy became increasingly popular in the United Kingdom at the beginning of the 1940s, where it was being labelled by the medial community as the miracle cure to insanity. Although many psychoanalysts opposed the procedure, the lobotomy became one of the most popular forms of mental health treatment, used to treat disorders including obsessive compulsive disorders, depression and schizophrenia. Over 1,000 lobotomies were carried out each year in clinics across the UK, and one of the most celebrated lobotomists in the world was located at Atkinson Morley hospital in Wimbledon.

The neurosurgeon Sir Wylie McKissock is reported to have performed over 3,000 lobotomies during his career, showing the quickness and simplicity of the operation. Alongside working at the Atkinson Morley hospital, Mckissock often travelled across the country performing lobotomies at smaller clinics for those in need.

walter_freeman-lobotomy

The lobotomy finally began to loose popularity in the late 1950s due to the increase of adverse side-effects and the rise in the production of pharmaceutical drugs, however, the trail of devastation it left behind did not dissipate so quickly.

Side effects:

  • Possible death
  • Loss of motor function
  • Incontinence
  • Epilepsy
  • Loss of cognitive function
  • Loss of emotion and personality
  • Lack of tact and discipline
  • Lack of empathy

Rosemary Kennedy, JFK’s sister was one of the most famous patients to experience a lobotomy, andRosemary-Kennedy her story is one like thousands of others. She became mentally handicapped at the age of 23 as a result of the procedure, and although the public did not known what was wrong with her at the time, her brother became increasingly outspoken about the issue in his role as President. In 1963, JFK performed his last bill signing, creating a 3 billion dollar authorising act, designed to create a national network of community mental health facilities.

Such facilities would be composed of small, tranquil care homes with patients being cared for and treat by the new pharmaceutical drug named Thorozine, thus eliminating the need for the lobotomy and changing the management of mental illnesses completely. As JFK was assassinated shortly after the bill signing, the scheme was not put into place, and the 3 billion dollars went to help fund the Vietnam war.

In 1950, the USSR officially banned the use of the lobotomy. Doctors and neurosurgeons concluded that the treatment defied the principles of humanity, turning “an insane person into an idiot.” Other countries followed suit by the 1970s, including several US states. In the UK however, the lobotomy remains legal.

1935: Electro Convulsive Therapy (ECT)

Convulsion Therapy was becoming increasingly popular within mainstream psychiatry, and many doctors experimented with their own versions of the therapy. One professor of neuropsychiatry, named Ugo Cerletti was developing his own idea of using electricity to shock patients as opposed to Metrazol. His first human experiment was in 1937, and according to Cerletti, the treatment began showing positive results after 10-15 sessions.

The purpose of the ECT was to induce a clonic seizure in a patient, allowing them to loose consciousness and convulse for 15 seconds. The most common theory is that this ‘jump-starts’ the brain and helps boost neurotransmission, whilst alleviating most mental illness, particularly schizophrenia. American psychiatrist, Peter Breggin is one of many critics of the procedure, claiming:

“Shock treatment is simply closed-head injury caused by an overwhelming current of electricity sufficient to cause a grand mal seizure. When the patient becomes apathetic, the doctor writes in the hospital chart, ‘No longer complaining.’ When the patient displays the euphoria commonly associated with brain damage, the doctor writes, ‘mood improved.’ Meanwhile, the individual’s brain and mind are so drastically injured that he or she is rendered unable to protest.”

ECT

Cerletti and his colleague, Lucio Bini, deemed the lack of protesting as another positive side effect of the treatment. The medial term was known as retrograde amnesia, and it caused the patients to forget the treatment had ever happened, and thus were more compliant. The simplicity and convenience of the ECT far outweighed the benefits of chemically induced seizures, and soon it became the therapy of choice.

The ECT procedure consisted of powerful shocks being sent to the brain via two electrodes known as paddles. Mouth guards, body restrains and drugs all had to be used to prevent damage to the patients’ bodies during the sessions, making this form of treatment particularly violent. The onset of World War II saw a drastic increase in technological development, and the ECT was one of the beneficiaries. The procedure became much safer and more comfortable for the patients, but questions were asked in regards to the treatment’s moral implications: As the patients could not remember having the ECT, how does this affect their informed consent?

IM.0072_zl

During the 1950s and 60s, an increasing amount of former patients and doctors had criticized the brutality of the ECT, and it began to fall in popularity. At the same time, pharmaceutical drugs were becoming readily available, providing institutions with a quicker, cheaper, and more humane method of treating the mentally ill.

  • Side effects

-According to the Royal College of Psychiatrists

ECT is a major procedure involving, over a few weeks, several epileptic seizures and several anaesthetics. It is used for people with severe illness who are very unwell and whose life may be in danger. As with any treatment, ECT can cause a number of side-effects. Some of these are mild and some are more severe.

  • Short-term

Many people complain of a headache immediately after ECT and of aching in their muscles. They may feel ‘fuzzy-headed’ and generally out of sorts, or even a bit sick. Some become distressed after the treatment and may be tearful or frightened during recovery. For most people, however, these effects settle within a few hours, particularly with help and support from nursing staff, simple pain killers and some light refreshment.

There may be some temporary loss of memory for the time immediately before and after the ECT.

Older people may be quite confused for two or three hours after a treatment. This can be reduced by changing the way the ECT is given (such as passing the current over only one side of the brain rather than across the whole brain).

There is a small physical risk from having a general anaesthetic – death or serious injury occurs in about 1 in 80,000 treatments, around the same level of risk in dental anaesthesia. However, as ECT is given in a course of treatments, the risk per course of treatment will be around 1 in 10 000.

  • Long-term

The greater concern is that of the long-term side effects, particularly memory problems. Surveys conducted by doctors and clinical staff usually find a low level of severe side-effects, maybe around 1 in 10. Service user-led surveys have found much more, maybe in half of those having ECT. Some surveys conducted by those strongly against ECT say there are severe side-effects in everyone.

Some difficulties with memory are present in the vast majority of those receiving ECT. Most people find these memories return when the course of ECT has finished and a few weeks have passed. However, some people do complain that their memory has been permanently affected, that their memories never come back. It is not clear how much of this is due to the ECT and how much is due to the depressive illness or other factors.

Some people have complained of more distressing experiences, such as feeling that their personalities have changed, that they have lost skills or that they are no longer the person they were before ECT. They say that they have never got over the experience and feel permanently harmed. What seems to be generally agreed is that the more ECT someone is given, the more it is likely to affect their memory.

ECT PATIENT MODERN

The ECT is still legal and practised throughout the world, although its usage has dwindled throughout the past decade. When a patient is coherent enough to refuse the treatment, it can not be given unless under extreme circumstances, even if they are detained under the Mental Health Act. If they are not able to make their own decisions, a team of doctors, a social worker and relatives of the patient gather to discuss whether the ECT would be appropriate.

For more information regarding ECT treatments, visit the Guts and Gore Document Vault! 

1950s: Pharmaceutical Drugs

Although there is substantial evidence to show that medication has been used for at least a century, but it was only in the 1950s when pharmaceutical drugs became widespread. The introduction of anti-psychotic drugs such as chlorpromazine (thorazine) offered patients an alternative form of treatment, and began to eliminate the need for the drastic treatments such as the lobotomy and ECT.

thorazineThorazine was first created by a team of French researchers who were aiming for a cure for malaria. Although they were unsuccessful in their attempts, they did discover that the drug had sedative side effects, and produced a ‘medicinal lobotomy.’ Thorozine was reported to reduce aggressive behaviour, anxiety, hallucinations and the desire to self-mutilate or harm others, and quickly other drugs based around its chemical compound were being produced on mass.

The popularity of pharmaceutical drugs, and chlorpromazine in particular, continued to soar throughout the 1960s and 70s. By the mid 1980s, doctors and scientists believed that there was sufficient evidence to indicate the fundamental importance of chlorpromazine within mental healthcare. A new disciple, neuropsychopharmacology, was then dedicated toward the study of mental pathology via the use of centrally acting medication . Since then, the diversity of pharmaceutical drugs has grown increasingly complex, leading to a mass market on a global scale.

Medications Organized by Trade Name
– According to the National Institute of Mental Health (NIMH)

Trade Name Generic Name FDA Approved Age
Combination Antipsychotic and Antidepressant Medication    
Symbyax (Prozac & Zyprexa) fluoxetine & olanzapine 18 and older
Antipsychotic Medications    
Abilify aripiprazole 10 and older for bipolar disorder, manic or mixed episodes;
13 to 17 for schizophrenia and bipolar;
Clozaril clozapine 18 and older
Fanapt iloperidone 18 and older
fluphenazine (generic only) fluphenazine 18 and older
Geodon ziprasidone 18 and older
Haldol haloperidol 3 and older
Invega paliperidone 18 and older
Loxitane loxapine 18 and older
Moban molindone 18 and older
Navane thiothixene 18 and older
Orap (for Tourette’s syndrome) pimozide 12 and older
perphenazine (generic only) perphenazine 18 and older
Risperdal risperidone 13 and older for schizophrenia;
10 and older for bipolar mania and mixed episodes;
5 to 16 for irritability associated with autism
Seroquel quetiapine 13 and older for schizophrenia;
18 and older for bipolar disorder;
10-17 for treatment of manic and mixed episodes of bipolar disorder.
Stelazine trifluoperazine 18 and older
thioridazine (generic only) thioridazine 2 and older
Thorazine chlorpromazine 18 and older
Zyprexia olanzapine 18 and older; ages 13-17 as second line treatment
for manic or mixed episodes of bipolar disorder
and schizophrenia.

 

Trade Name Generic Name FDA Approved Age
Antidepressant Medications (also used for anxiety disorders)    
Anafranil (tricyclic) clomipramine 10 and older (for OCD only)
Asendin amoxapine 18 and older
Aventyl (tricyclic) nortriptyline 18 and older
Celexa (SSRI) citalopram 18 and older
Cymbalta (SNRI) duloxetine 18 and older
Desyrel trazodone 18 and older
Effexor (SNRI) venlafaxine 18 and older
Elavil (tricyclic) amitriptyline 18 and older
Emsam selegiline 18 and older
Lexapro (SSRI) escitalopram 18 and older; 12 – 17 (for major depressive disorder)
Ludiomil (tricyclic) maprotiline 18 and older
Luvox (SSRI) fluvoxamine 8 and older (for OCD only)
Marplan (MAOI) isocarboxazid 18 and older
Nardil (MAOI) phenelzine 18 and older
Norpramin (tricyclic) desipramine 18 and older
Pamelor (tricyclic) nortriptyline 18 and older
Parnate (MAOI) tranylcypromine 18 and older
Paxil (SSRI) paroxetine 18 and older
Pexeva (SSRI) paroxetine-mesylate 18 and older
Pristiq desvenlafaxine (SNRI) 18 and older
Prozac (SSRI) fluoxetine 8 and older
Remeron mirtazapine 18 and older
Sarafem (SSRI) fluoxetine 18 and older for premenstrual dysphoric disorder (PMDD)
Sinequan (tricyclic) doxepin 12 and older
Surmontil (tricyclic) trimipramine 18 and older
Tofranil (tricyclic) imipramine 6 and older (for bedwetting)
Tofranil-PM (tricyclic) imipramine pamoate 18 and older
Vivactil (tricyclic) protriptyline 18 and older
Wellbutrin bupropion 18 and older
Zoloft (SSRI) sertraline 6 and older (for OCD only)

 

Trade Name Generic Name FDA Approved Age
Mood Stabilizing and Anticonvulsant Medications    
Depakote divalproex sodium (valproic acid) 2 and older (for seizures)
Eskalith lithium carbonate 12 and older
Lamictal lamotrigine 18 and older
lithium citrate (generic only) lithium citrate 12 and older
Lithobid lithium carbonate 12 and older
Neurontin gabapentin 18 and older
Tegretol carbamazepine any age (for seizures)
Topamax topiramate 18 and older
Trileptal oxcarbazepine 4 and older

 

Trade Name Generic Name FDA Approved Age
Anti-anxiety Medications
(All of these anti-anxiety medications are benzodiazepines, except BuSpar)
   
Ativan lorazepam 18 and older
BuSpar buspirone 18 and older
Klonopin clonazepam 18 and older
Librium chlordiazepoxide 18 and older
oxazepam (generic only) oxazepam 18 and older
Tranxene clorazepate 18 and older
Valium diazepam 18 and older
Xanax alprazolam 18 and older

 

Trade Name Generic Name FDA Approved Age
ADHD Medications
(All of these ADHD medications are stimulants, except Intuniv and Straterra.)
   
Adderall amphetamine 3 and older
Adderall XR amphetamine (extended release) 6 and older
Concerta methylphenidate (long acting) 6 and older
Daytrana methylphenidate patch 6 and older
Desoxyn methamphetamine 6 and older
Dexedrine dextroamphetamine 3 and older
Dextrostat dextroamphetamine 3 and older
Focalin dexmethylphenidate 6 and older
Focalin XR dexmethylphenidate (extended release) 6 and older
Intuniv guanfacine 6 and older
Metadate ER methylphenidate (extended release) 6 and older
Metadate CD methylphenidate (extended release) 6 and older
Methylin methylphenidate (oral solution and chewable tablets) 6 and older
Ritalin methylphenidate 6 and older
Ritalin SR methylphenidate (extended release) 6 and older
Ritalin LA methylphenidate (long-acting) 6 and older
Strattera atomoxetine 6 and older
Vyvanse lisdexamfetamine dimesylate 6 and older

 

Generic Name Trade Name FDA Approved Age
Combination Antipsychotic and Antidepressant Medication    
fluoxetine & olanzapine Symbyax (Prozac & Zyprexa) 18 and older
Antipsychotic Medications    
aripiprazole Abilify 10 and older for bipolar disorder, manic or mixed episodes;
13 to 17 for schizophrenia and bipolar;
chlorpromazine Thorazine 18 and older
clozapine Clozaril 18 and older
fluphenazine (generic only) fluphenazine 18 and older
haloperidol Haldol 3 and older
iloperidone Fanapt 18 and older
loxapine Loxitane 18 and older
molindone Moban 18 and older
olanzapine Zyprexa 18 and older; ages 13-17 as second line treatment
for manic or mixed episodes of bipolar disorder and schizophrenia
paliperidone Invega 18 and older
perphenazine (generic only) perphenazine 18 and older
pimozide (for Tourette’s syndrome) Orap 12 and older
quetiapine Seroquel 13 and older for schizophrenia;
18 and older for bipolar disorder;
10-17 for treatment of manic and mixed episodes of bipolar disorder
risperidone Risperdal 13 and older for schizophrenia;
10 and older for bipolar mania and mixed episodes;
5 to 16 for irritability associated with autism
thioridazine (generic only) thioridazine 2 and older
thiothixene Navane 18 and older
trifluoperazine Stelazine 18 and older
ziprasidone Geodon 18 and older

 

Generic Name Trade Name FDA Approved Age
Antidepressant Medications (also used for anxiety disorders)    
amitriptyline (tricyclic) Elavil 18 and older
amoxapine Asendin 18 and older
bupropion Wellbutrin 18 and older
citalopram (SSRI) Celexa 18 and older
clomipramine (tricyclic) Anafranil 10 and older (for OCD only)
desipramine (tricyclic) Norpramin 18 and older
desvenlafaxine (SNRI) Pristiq 18 and older
doxepin (tricyclic) Sinequan 12 and older
duloxetine (SNRI) Cymbalta 18 and older
escitalopram (SSRI) Lexapro 18 and older; 12 – 17 (for major depressive disorder)
fluoxetine (SSRI) Prozac 8 and older
fluoxetine (SSRI) Sarafem 18 and older for premenstrual dysphoric disorder (PMDD)
fluvoxamine (SSRI) Luvox 8 and older (for OCD only)
imipramine (tricyclic) Tofranil 6 and older (for bedwetting)
imipramine pamoate (tricyclic) Tofranil-PM 18 and older
isocarboxazid (MAOI) Marplan 18 and older
maprotiline (tricyclic) Ludiomil 18 and older
mirtazapine Remeron 18 and older
nortriptyline (tricyclic) Aventyl, Pamelor 18 and older
paroxetine (SSRI) Paxil 18 and older
paroxetine mesylate (SSRI) Pexeva 18 and older
phenelzine (MAOI) Nardil 18 and older
protriptyline (tricyclic) Vivactil 18 and older
selegiline Emsam 18 and older
sertraline (SSRI) Zoloft 6 and older (for OCD only)
tranylcypromine (MAOI) Parnate 18 and older
trazodone Desyrel 18 and older
trimipramine (tricyclic) Surmontil 18 and older
venlafaxine (SNRI) Effexor 18 and older

 

Generic Name Trade Name FDA Approved Age
Mood Stabilizing and Anticonvulsant Medications    
carbamazepine Tegretol any age (for seizures)
divalproex sodium (valproic acid) Depakote 2 and older (for seizures)
gabapentin Neurontin 18 and older
lamotrigine Lamictal 18 and older
lithium carbonate Eskalith, Lithobid 12 and older
lithium citrate (generic only) lithium citrate 12 and older
oxcarbazepine Trileptal 4 and older
topiramate Topamax 18 and older

 

Generic Name Trade Name FDA Approved Age
Anti-anxiety Medications
(All of these anti-anxiety medications are benzodiazepines, except buspirone.)
   
alprazolam Xanax 18 and older
buspirone BuSpar 18 and older
chlordiazepoxide Librium 18 and older
clonazepam Klonopin 18 and older
clorazepate Tranxene 18 and older
diazepam Valium 18 and older
lorazepam Ativan 18 and older
oxazepam (generic only) oxazepam 18 and older

 

Generic Name Trade Name FDA Approved Age
ADHD Medications
(All of these ADHD medications are stimulants, except atomoxetine and guanfacine)
   
amphetamine Adderall 3 and older
amphetamine (extended release) Adderall XR 6 and older
atomoxetine Strattera 6 and older
dexmethylphenidate Focalin 6 and older
dexmethylphenidate (extended release) Focalin XR 6 and older
dextroamphetamine Dexedrine, Dextrostat 3 and older
guanfacine Intuniv 6 and older
lisdexamfetamine dimesylate Vyvanse 6 and older
methamphetamine Desoxyn 6 and older
methylphenidate Ritalin 6 and older
methylphenidate (extended release) Metadate CD, Metadate ER, Ritalin SR 6 and older
methylphenidate (long-acting) Ritalin LA, Concerta 6 and older
methylphenidate patch Daytrana 6 and older
methylphenidate (oral solution and chewable tablets) Methylin 6 and older


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