General Considerations for Vulnerable Populations

Children

Children are generally more prone to serious disruptions by psychiatric medications that may interfere with development. Their livers and kidneys may not be developed enough to efficiently eliminate the drugs out of the body, although the opposite is generally the case when relatively higher doses are required for efficacy, partly because of children's faster metabolic capacity. However, few controlled studies have been done to obtain data on the efficacy and safety of psychiatric medications in children (Birmaher & Axelson, 2005). In addition, how these drugs effect growth and development with long-term use has not been well studied.

Adolescents

Adolescents often fall in between children and adults in terms of proper dosing based on body size. As with children, long-term effects and efficacy for adolescents have not been well studied. Teens may also be particularly concerned with drug side effects that negatively affect body image like weight gain and hair loss.

Older Adults

Older adults may be vulnerable to side effects of the medications in general for the following reasons:

• Decreased body water may lead to higher concentrations of medications.
• Decreased plasma proteins may lead to increased serum level of a drug that is not bound to proteins in the bloodstream.
• Increased portion of fat in the body may cause retention of a fat-soluble psychiatric medication and prolong its elimination half-life.
• Decreased liver and kidney function may also prolong elimination half-life of a medication.
• In addition, complex drug regimens which may be from multiple prescribers may be associated with poor compliance.