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One such opportunity is discontinuation or deprescribing strategies of pharmacological treatments in children and adolescents with psychiatric disorders (Dinnissen et al., 2024). Quality guidelines highlight knowledge gaps related to the identification of treatment endpoints and exit strategies for pharmacological treatment in our patient population (Walter et al., 2023). These knowledge gaps are magnified when considering cross-titration strategies. In this issue, Stimpfl and colleagues (Stimpfl et al., 2024) provide a systematic review and erudite synthesis of existing discontinuation literature focused on antidepressants in children and adolescents. The authors identified and reviewed findings from 3026 patients across 13 randomized controlled trials. Hyperbolic and pragmatic approaches are often considered in clinical practice. Stimpfl and colleagues champion a patient-centered approach considering pharmacodynamics, pharmacokinetics, risk of relapse, and withdrawal symptoms (Stimpfl et al., 2024). Pharmacological discontinuation and cross-titration research is an important priority for the Journal of Child and Adolescent Psychopharmacology in 2025 and beyond.
Patients with Tourette’s Syndrome and tic disorders often have complex presentations and treatment needs (Farhat et al., 2023). Pain syndromes may be an important related or co-occurring condition for patients with Tourette’s Syndrome. In this issue, Green and colleagues review existing literature focused on tic disorders and the interplay of pain. It appears that at least half of patients with Tourette’s Syndrome struggle with pain and its impact on quality of life. The authors highlight important translational opportunities to improve clinical rating scales, further understanding of the bidirectional relationship between pain syndromes and Tourette’s Syndrome, and the prospect of novel therapeutic approaches (Green et al., 2024).
Research focused on lithium treatment for youth with mood disorders continues to develop but there is a need for more long-term studies (Findling et al., 2019). In this issue, Pacini and colleagues present work from a longitudinal cohort study (N = 36) of adolescents with bipolar disorder treated with Extended-Release Lithium Sulfate (Placini et al., 2024). Depressive symptoms, aggression, emotional dysregulation, suicidal thoughts, and self-injurious behavior improved over the course of follow-up assessments. Common side effects included increased appetite (this appeared to decrease over time), polyuria, polydipsia, tremors, headaches, and fatigue. Less common but more impairing side effects included hyperhidrosis, nausea, vomiting, and agitation. Notwithstanding limitations, this study adds important insights to a developing evidence base for the use of lithium for youth with mood disorders (Placini et al., 2024).
Also in this issue, Schein and colleagues present findings from a caregiver survey study (N = 401) focused on quality of life and side effect outcomes related to pharmacological treatments for attention-deficit/hyperactivity disorder (Schein et al., 2024). The majority of participants in the sample reported challenges related to side effects with sleep and appetite disruptions most frequently. The number of side effects was associated with patient quality of life, caregiver activity, and caregiver depressive and anxiety symptoms (Schein et al., 2024). This highlights the importance of considering tolerability for intervention discovery (Baweja et al., 2024).
We round this issue out with an Advanced Pharmacology piece from Dr. Coffey and colleagues. This case report outlines the complex treatment considerations of a teenager struggling with depression and polysubstance use disorders. Off-label, adjunctive treatment with naltrexone was initiated during the patient’s fourth hospitalization and was an important part of a broader treatment plan that facilitated a 3-week period of stability and entry into residential treatment (Organista et al., 2024).
This month we honor and thank our peer reviewers from 2024. Happy 35th anniversary colleagues. Your inspiration, expertise, and engagement are critical in shaping our literature and advancing our journal. We hope you enjoy this issue of the Journal of Child and Adolescent Psychopharmacology.