Psychopharmacology in children and adolescents: unmet needs and opportunities

Samuele Cortese; Diane Purper-Ouakil; Alan Apter; Celso Arango; Inmaculada Baeza; Tobias Banaschewski; Jan Buitelaar; Josefina Castro-Fornieles; David Coghill; David Cohen; Christoph U Correll; Edna Grünblatt; Pieter J Hoekstra; Anthony James; Pia Jeppesen; Péter Nagy; Anne Katrine Pagsberg; Mara Parellada; Antonio M Persico; Veit Roessner; Paramala Santosh; Emily Simonoff; Dejan Stevanovic; Argyris Stringaris; Benedetto Vitiello; Susanne Walitza; Abraham Weizman; Ian C K Wong; Gil Zalsman; Alessandro Zuddas; Sara Carucci; Florence Butlen-Ducuing; Maria Tome; Myriam Bea; Christine Getin; Nina Hovén; Asa Konradsson-Geuken; Daphne Lamirell; Nigel Olisa; Begonya Nafria Escalera; Carmen Moreno

doi:10.1016/S2215-0366(23)00345-0

Psychopharmacology in children and adolescents: unmet needs and opportunities

Lancet Psychiatry. 2024 Feb;11(2):143-154. doi: 10.1016/S2215-0366(23)00345-0. Epub 2023 Dec 7.

Authors

Samuele Cortese¹, Diane Purper-Ouakil², Alan Apter³, Celso Arango⁴, Inmaculada Baeza⁵, Tobias Banaschewski⁶, Jan Buitelaar⁷, Josefina Castro-Fornieles⁵, David Coghill⁸, David Cohen⁹, Christoph U Correll¹⁰, Edna Grünblatt¹¹, Pieter J Hoekstra¹², Anthony James¹³, Pia Jeppesen¹⁴, Péter Nagy¹⁵, Anne Katrine Pagsberg¹⁶, Mara Parellada⁴, Antonio M Persico¹⁷, Veit Roessner¹⁸, Paramala Santosh¹⁹, Emily Simonoff²⁰, Dejan Stevanovic²¹, Argyris Stringaris²², Benedetto Vitiello²³, Susanne Walitza¹¹, Abraham Weizman²⁴, Ian C K Wong²⁵, Gil Zalsman²⁶, Alessandro Zuddas²⁷, Sara Carucci²⁷, Florence Butlen-Ducuing²⁸, Maria Tome²⁸, Myriam Bea²⁹, Christine Getin³⁰, Nina Hovén³¹, Asa Konradsson-Geuken³², Daphne Lamirell³³, Nigel Olisa³³, Begonya Nafria Escalera³⁴, Carmen Moreno⁴

Affiliations

¹ Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy. Electronic address: samuele.cortese@soton.ac.uk.
² Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, France; INSERM U 1018, CESP, Psychiatrie du développement - Evaluer et traiter les troubles émotionnels et du neurodéveloppement (ETE-ND), Villejuif, France.
³ Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Ivcher School of Psychology, Reichman University, Herzliya, Israel.
⁴ Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain.
⁵ Child and Adolescent Psychiatry and Psychology Department, SGR01319, Hospital Clínic de Barcelona, Neurosciences Institute, University of Barcelona, IDIBAPS, CIBERSAM-ISCIII, Barcelona, Spain.
⁶ Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁷ Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands; Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.
⁸ Departments of Paediatrics and Psychiatry, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's research Institute, Melbourne, VIC, Australia.
⁹ Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne Université, UPMC, Paris, France.
¹⁰ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Psychiatry Research, Northwell Health, Zucker Hillside Hospital, New York, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine, Hempstead, NY, USA; Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA.
¹¹ Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland.
¹² University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry & Accare Child Study Center, Groningen, Netherlands.
¹³ Department of Psychiatry, Oxford University, and Oxford Health Biomedical Research Centre, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
¹⁴ Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.
¹⁵ Bethesda Children's Hospital, Budapest, Hungary.
¹⁶ Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
¹⁷ Child & Adolescent Neuropsychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
¹⁸ Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
¹⁹ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), London, UK.
²⁰ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust (SLaM), London, UK; Maudsley Biomedical Research Centre for Mental Health, London, UK.
²¹ Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²² Department of Clinical, Educational and Health Psychology, Division of Psychiatry, University College London, London, UK; Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.
²³ Division of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.
²⁴ Geha Mental Health Center, Petah Tikva, and Department of Psychiatry, Faculty of Medicine, and Laboratory of Biological and Molecular Psychiatry, Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel.
²⁵ Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK.
²⁶ Geha Mental Health Center, Petah Tikva, and Department of Psychiatry, Faculty of Medicine, and Laboratory of Biological and Molecular Psychiatry, Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA.
²⁷ Department Biomedical Science, Sect Neuroscience & Clinical Pharmacology, University of Cagliari, A. Cao Paediatric Hospital, Cagliari, Italy.
²⁸ European Medicines Agency, Human Medicines Division, Amsterdam, Netherlands.
²⁹ ADHD Germany, Berlin, Germany.
³⁰ Hypersupers TDAH France, National Association, Paris, France.
³¹ ADHD Europe, Brussels, Belgium.
³² Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden; European Federation of Associations of Families of People with Mental Illness (EUFAMI), Leuven, Belgium.
³³ Global Alliance of Mental Illness Advocacy Networks- Europe (GAMIAN Europe), Ixelles, Belgium.
³⁴ Patient Engagement in Research Department, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Innovation Department Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain.

PMID: 38071998
DOI: 10.1016/S2215-0366(23)00345-0

Abstract

Psychopharmacological treatment is an important component of the multimodal intervention approach to treating mental health conditions in children and adolescents. Currently, there are many unmet needs but also opportunities, alongside possible risks to consider, regarding the pharmacological treatment of mental health conditions in children and adolescents. In this Position Paper, we highlight and address these unmet needs and opportunities, including the perspectives of clinicians and researchers from the European College of Neuropsychopharmacology-Child and Adolescent Network, alongside those of experts by lived experience from national and international associations, via a survey involving 644 participants from 13 countries, and of regulators, through representation from the European Medicines Agency. We present and discuss the evidence base for medications currently used for mental disorders in children and adolescents, medications in the pipeline, opportunities in the development of novel medications, crucial priorities for the conduct of future clinical studies, challenges and opportunities in terms of the regulatory and legislative framework, and innovations in the way research is conducted, reported, and promoted.

Publication types

Review

MeSH terms

Adolescent
Humans
Mental Disorders* / drug therapy
Mental Health
Psychopharmacology*