A recent Centers for Disease Control (CDC) report suggested that as many as 1 in 5 children between the ages of 5 and 17 may have some mental disorder (e.g., ADHD, autism, anxiety, depression) (CDC, 2013). The incidence of bipolar disorder in children and adolescents has also increased 40 times recently (Moreno et al., 2007), and it is now estimated that 1 in 36 children have been diagnosed with an autism spectrum disorder (CDC, 2023). Why has there been such an increase in these numbers? This important question has no single answer. Some believe that greater public awareness has increased teacher and parent referrals. Some attribute the rise to changes in diagnostic criteria. Still others suggest environmental factors, prenatally or postnatally, have contributed to this upsurge.

This question raises further controversy regarding the treatment of young individuals. Many psychotropic drugs used for treating psychiatric disorders have been tested in adults, but few have been tested for safety or efficacy with children or adolescents. The most well-established psychotropics prescribed for children and adolescents are the psychostimulant drugs for treating attention deficit hyperactivity disorder (ADHD), and there are clinical data on these drugs’ effectiveness. However, we know far less about the safety and efficacy in young populations of the drugs typically prescribed for treating anxiety, depression, or other psychiatric disorders. The young brain continues to mature until well after age 20, so some scientists are concerned that drugs that alter neuronal activity in the developing brain could have significant consequences. Clinical trials in minors are needed to test the safety and effectiveness of these drugs, raising ethical concerns about consent, participation, and compensation.

The Elderly and Psychopharmacology

Elderly populations are often excluded from psychotropic drug safety and efficacy trials. Currently, little high-quality evidence is available to guide prescribing for older adults—clinical trials often exclude people with multiple comorbidities (other diseases, conditions, etc.), which are typical for elderly populations (see Hilmer & Gnjidict, 2008; Pollock et al., 2008). This is a serious issue because the elderly consume a disproportionate number of the prescription meds prescribed. The term polypharmacy refers to the use of multiple drugs, which is very common in elderly populations in the United States. Demographic projections suggest that by 2030, individuals aged 65 or older will constitute approximately 20% of the U.S. population, potentially accounting for 40% of prescribed medication consumption. Table 3 illustrates why standard clinical trials poorly capture the reality of elderly populations.

Drug metabolism often slows considerably for elderly populations, so less of a drug can produce the same effect (or all too often, too much of a drug can result in a variety of side effects). One of the greatest risk factors for elderly populations is falling and breaking bones, which can happen if the elderly person gets dizzy from too much of a drug. Psychotropic medications can also reduce bone density, thus worsening the consequences of falls (Brown & Mezuk, 2012). Despite growing awareness, geriatric pharmacotherapy presents complex medical and ethical challenges.

This chapter provided an introduction to some of the important areas in the field of psychopharmacology. Understanding psychopharmacology is crucial for understanding behavior, and has significant societal implications.