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“Someone is trying to jump off a bridge and they give him ketamine in the ambulance to calm him down and 9 months later, he says, ‘I haven’t felt suicidal for 9 months.’ “When enough stories like that started to pile up, doctors said, ‘Maybe there’s something here,’” says Stewart, an emergency physician and founder of Insight Ketamine in Santa Fe, NM. Like the drug itself, Stewart got his start in combat medicine during the Vietnam War. Some doctors also use ketamine to treat suicidal thoughts.
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Codeine is a naturally occurring constituent of opium and is classed as an opiate pain-killer. It is closely related to morphine, but is much less potent. Codeine is used to relieve mild to moderate pain, to suppress cough, and to treat diarrhoea. These effects make it particularly useful for treating pain associated with coughing, and pain associated with diarrhoea (eg gastroenteritis, and some forms of irritable bowel syndrome). Codeine is too constipating for long-term use on its own, and is usually combined with other analgesics. It helps to boost the effects of other analgesics such as aspirin, paracetamol or ibuprofen. The combination of codeine plus aspirin is particularly effective, and gives a better result than expected when used together. Codeine works directly on the brain, spinal cord and peripheral nerves to reduce the transmission of pain signals, and the way pain is perceived in the brain. It changes the way you feel pain so that, although it may still be there, it no longer seems to matter.
Tramadol is associated with both opioid and antidepressant-like adverse effects. Tramadol is associated with adverse effects seen in both opioid and antidepressant classes of medicine (Table 1).3 Tramadol has less risk of respiratory depression and constipation than codeine and dihydrocodeine because it is only a partial µ-opioid receptor agonist.2 However, nausea, vomiting and dizziness can be expected in at least 10% of patients taking tramadol. There is an increased risk of serotonin toxicity with the use of tramadol and it is contraindicated in patients with uncontrolled epilepsy or those who have taken a monoamine oxidase inhibitor in the last 14 days.5 Caution is advised when considering tramadol in combination with other serotonergic medicines, and if the combination is prescribed, patients should be advised to cease treatment if they develop symptoms of serotonin syndrome, e.g. neuromuscular or autonomic effects or changes in mental state.
Although many parents reported side effects, they can often be managed. For example, some children have problems later in the day and a long-acting formulation is best, but sometimes the effect might persist into the evening, suppressing appetite for dinner and delaying bedtime. “There is no substitute for carefully evaluating the effect of a medication after it has been used to determine if it should be increased, decreased, or switched to something else,” Goldstein says. Parents should also note that a child might begin to show withdrawal symptoms when a dose wears off, and might need tips for avoiding this. These management skills are something that can be developed with the doctor responsible for prescribing the medication. For more help understanding ADHD and what you can do to help your child, including whether to medicate, see HealthPoint.net’s ADHD guide and Decision Point tool.
Ramelteon ( Rozerem ): This sleep medication works differently than the others. It works by targeting the sleep-wake cycle, not by depressing the central nervous system. It is prescribed for people who have trouble falling asleep. Rozerem can be prescribed for long-term use, and the drug has shown no evidence of abuse or dependence.
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