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Clozapine for Teens: What It’s for and How It Works

Author:
Emma Loker
Emma Loker
B.S.
Editor:
Aja Chavez
Aja Chavez
AMFT, APCC
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If your teen is struggling with their mental health symptoms, as a parent, this will understandably be distressing to see. You may worry about making the best choice for their treatment, or if medication poses more risks than benefits for their well-being. These concerns are normal. 

Psychosis is a symptom of certain mental health conditions. It’s defined by the National Institute of Mental Health as “a collection of symptoms that affect the mind, where there has been some loss of contact with reality.” There may be hallucinations (seeing or hearing things that others do not), delusions (false beliefs), incoherent speech, or behaviors that are inappropriate for certain situations.1

If any of these experiences are familiar to you or someone you love, treatment options such as medication may have already been explored. It’s good to know that “first-line” medications or treatment options don’t always work for everyone. At this stage, teen mental health treatment with clozapine may play a valuable role in providing relief. 

Mission Prep’s care team can help you explore how clozapine (sold under the brand name “Clozaril”) can make a difference. This page can also serve as a useful guide, as it breaks down: 

  • What clozapine is and how it works
  • Teen mental health treatment with clozapine – how it works for schizophrenia, depression, bipolar disorder, and ADHD
  • If clozapine is suitable for use in children and adolescents 
  • Clozapine dosage and monitoring guidelines for teenagers
  • Clozapine side effects in teenagers
  • How to stop clozapine safely
  • Questions to ask your healthcare provider about clozapine
  • How Mission Prep can help when deciding if clozapine is right for your teen
Clozapine for Teens

Teen Mental Health Treatment With Clozapine: How Does Clozapine Work?

Clozapine is not the “go-to” treatment for mental health conditions in teens. However, a provider may consider it if a teen has symptoms that impact their daily life, or if they haven’t responded to previous treatments. 

Like most antipsychotics, clozapine plays a role in the release of dopamine and serotonin – key brain chemicals in the regulation of mood. Studies also show that clozapine has an effect on receptors in the brain linked to the development of psychosis. Clozapine binds to these receptors and reduces symptoms, proving it to be effective in the treatment of mental health conditions such as schizophrenia.2

Additionally, research has shown a link between clozapine treatment and a lower risk of suicide, as well as improved cognition, which leads to a better quality of life.3

Clozapine Dosage for Teenagers

If it’s determined through an evaluation that a teen could benefit from clozapine treatment, it’s worth knowing the dose regimen.

Before starting treatment, a medical professional will take a blood sample to measure a type of white blood cell called a “neutrophil” – this will become their Absolute Neutrophil Count (ANC). The teen’s ANC will be monitored regularly throughout treatment and will guide their clozapine dosage. 

As a guideline, for adults, the clozapine starting dose is normally 12.5mg once or twice daily. The total daily dose can be increased in increments of 25-50mg per day if well tolerated, to reach a target daily dose of 300-450mg per day (in divided doses) by the end of 2 weeks.
After this, the dose can be increased once or twice weekly, in increments of up to 100mg. The maximum dose is 900mg per day.4

Note that the dose must be gradually increased in this way to avoid adverse effects, which we’ll share later. Dosing for adolescents and teenagers will likely be lower than that for adults. Your healthcare provider will be able to adjust dosing carefully according to your child’s age, weight, and reaction to the medication.

Rest assured that while clozapine dosage might sound complex, the skilled team at Mission Prep will be available to help. 

What Is Clozapine Used for?

Clozapine is the only anti-psychotic medicine approved by the Food and Drug Administration (FDA) for treatment-resistant schizophrenia. It is also approved by the FDA for the treatment of suicidal thoughts in schizophrenia.5

Clozapine is also sometimes used “off-label.” This is where a healthcare professional prescribes a medication outside the officially approved list of conditions or patients. For instance, clozapine has shown promising results in treating conditions such as depression, attention deficit hyperactivity disorder (ADHD), and bipolar disorder.  So while using clozapine to treat these conditions is considered “off-label,” the same quality of care will be given by your healthcare provider in any case. 

However, clozapine will likely only be considered for treating these conditions in teens if other medications, such as SSRIs and SNRIs, have proven to be ineffective. Let’s take a closer look at how clozapine can benefit the treatment of these mental health issues. 

Clozapine for Treatment-Resistant Schizophrenia

The American Psychological Association (APA) defines schizophrenia as a “serious mental illness characterized by incoherent or illogical thoughts, bizarre behavior and speech, and delusions or hallucinations, such as hearing voices.”6

As discussed previously, clozapine can play an important role in “treatment-resistant” schizophrenia. For instance, research has shown clozapine to be more effective than other antipsychotics in the reduction of symptoms, improving adherence (taking medication as prescribed long term), and lowering rates of re-hospitalisation.7

However, the majority of studies focus on clozapine for schizophrenia treatment in the adult population. But how well does it work for young people? 

Clozaril for Schizophrenia Treatment in Teens

Young people with schizophrenia can be described as having “early-onset” schizophrenia, where symptoms appear earlier in life. This can be particularly challenging during a time of high social and academic pressure. 

The good news is that clozaril for schizophrenia treatment in teens has shown positive results. For example, Clozaril treatment over a 15-year period demonstrated meaningful improvement in a sample of 28 young people with treatment-resistant schizophrenia.8

Another study showed positive results in a group of teens being treated with clozapine in hospital, where most experienced clinical improvement.9

How Clozapine Works for Teen Depression

Depression can be particularly challenging in a young person’s life. The World Health Organisation (WHO) describes depression as “A common mental disorder…involving a depressed mood or loss of pleasure or interest in activities for long periods of time.”10 

Clozapine can be used “off label” for depression, where other “first-line” treatments haven’t worked. It works by binding to receptors responsible for regulating the amount of serotonin in the brain, helping to balance mood and positive outlook. 

Research has found that clozapine is effective for treatment-resistant depression, producing improvement in mood and reduction in psychotic symptoms.11

Using Clozapine for Teen Bipolar Disorder

Bipolar disorder is a mental health condition characterized by mood swings from one extreme to another. During a manic episode, a teen may experience an extremely “high” mood with lots of energy (feeling very happy, excited, overactive). On the contrary, during a depressive episode, they may encounter a depressed mood (feeling sad, irritable, empty).12

Bipolar disorder can be difficult to navigate for anyone, and can be challenging, especially in a more vulnerable population such as teenagers and young people. 

Fortunately, research has shown some promising results when bipolar disorder is treated with clozapine. For instance, one study highlighted its effectiveness in treating a sample of 39 adolescents, with reductions in symptoms seen in most cases.13

Clozapine for ADHD in Teens

According to the National Institute of Mental Health, ADHD (Attention Deficit Hyperactivity Disorder) is characterized by an ongoing pattern of one or more of the following symptoms:

  • Inattention: Difficulty paying attention, keeping on task, or staying organized
  • Hyperactivity: Moving around often (including during inappropriate times), feeling restless, or talking excessively
  • Impulsivity: Such as interrupting, intruding on others, or having trouble waiting one’s turn.
ADHD is one of the most common disorders diagnosed in children. Symptoms begin in childhood and usually continue into the teen years and adulthood – especially if left untreated.14 There is limited research that specifically looks at the effect of clozapine on teens with diagnosed ADHD. However, one study has shown clozapine for ADHD in teens to be effective in the short term for reducing disruptive or even aggressive behaviours, which can appear in ADHD in some cases.15

Clozapine Side Effects in Teenagers

You may be wondering; What are the side effects of clozapine? As with any medication, it’s important to consider any potential risks. Yet, note that side effects vary from person to person. How one teen reacts to clozapine may not be the same as the next. 

One of the most serious risks associated with clozaril is agranulocytosis. This condition occurs when the number of white blood cells in the body drops significantly, making the immune system weaker and more vulnerable to infections.

Important Clozaril side effects also include:

  • Seizures or convulsions: The likelihood of seizures increases with higher doses 
  • Irregular or rapid heartbeat: If this happens, the dosage may be adjusted, or another medication may be used to address the issue
  • Myocarditis (inflammation of the heart muscle): The risk of this side effect is highest during the first month of clozaril treatment
  • Orthostatic hypotension: A sudden drop in blood pressure when standing up quickly. This is most likely to occur when starting clozaril therapy
  • Hypersalivation (excess saliva, drooling): This can be embarrassing if it occurs, but fortunately, it is very treatable 

 

Other common clozapine side effects in teenagers include drowsiness, dizziness, headaches, tremors, rapid heart rate, low blood pressure, fainting, drooling, excessive sweating, dry mouth, visual issues, constipation, nausea, and fever.16

Your provider will closely monitor your child’s physical and emotional reactions to clozapine, ensuring that the benefits of the medication outweigh any risks.  

Clozapine Monitoring Guidelines

Your teen’s mental health symptoms and well-being will consistently be monitored by their healthcare provider throughout treatment to ensure they’re benefiting from the medication. 

However, one of the serious risks of Clozaril is a significant reduction in white blood cells (agranulocytosis). Therefore, it’s important to undergo regular blood tests before, during, and after treatment with Clozaril. Before starting Clozaril, your doctor will review your teen’s medical history and perform a blood test to ensure their white blood cell count is within a normal range. 

During the first 18 weeks of treatment, your teen will likely need weekly blood tests. After that, testing should be done at least once a month. If a decrease in white blood cells is detected, Clozaril treatment must be stopped immediately. Their white blood cell count should return to normal after discontinuing the medication, however, they will still need blood tests for four weeks after completing Clozaril treatment.

Your provider may also conduct a physical examination prior to clozapine treatment, such as testing heart health. Yet this may only be necessary if your teen has specific concerns. Additionally, Clozaril can affect blood lipids and may lead to weight gain. Your provider may track your weight and lipid levels as part of your treatment, as well as recommend healthy lifestyle and nutrition changes.17

Clozapine for Teens: What It’s for and How It Works

Stopping Clozapine Safely in Teens

Stopping clozapine suddenly may lead to withdrawal symptoms, which can include sweating, headaches, nausea, vomiting, and diarrhea. Without prompt treatment, these symptoms could lead to more severe side effects, and the original mental health symptoms may return. 

If discontinuing treatment is necessary, a healthcare professional will recommend a safe and gradual dose reduction, typically by 12.5 mg every one to two weeks.17

To put it simply, stopping clozapine safely in teens is best done slowly and under the guidance of a professional. There’s no need to rush this process.

How Does Clozapine Compare to Other Antipsychotics?

Clozapine vs other antipsychotics has been well researched. For instance, one review showed that clozapine was slightly more effective than zotepine and showed better results than risperidone.  Although clozapine has side effects, it remains a highly effective treatment. In the same review, it showed that it caused fewer movement issues than risperidone and less prolactin (a hormone that can influence mood and emotional regulation) increase than olanzapine, quetiapine, and zotepine.  While it may lead to more sedation, excess saliva, and weight gain, these side effects are manageable, and its effectiveness makes it a top choice for treatment-resistant patients.18

Questions to Ask Your Healthcare Provider About Clozapine

Is There a Link Between Clozapine and Sleep Problems in Teens?

While research is limited in teenagers specifically, some studies have shown increased sedation during the day, but also longer time spent sleeping at bedtime. This is worth considering, and your healthcare provider will be able to advise.19

Clozapine and Risk of Seizures in Teens: Do I Need to Be Concerned?

Clozapine is associated with a risk of seizures, but this varies depending on the dose. Research has shown that higher doses come with a greater risk. This is why careful monitoring is required, and your healthcare provider will take great care in doing so.20

Clozapine and Weight Gain in Teenagers – Is This a Side Effect?

There is a link between clozapine and appetite changes in teens. As mentioned before, weight gain is an established side effect that may happen during treatment. If this is a particular concern, your healthcare provider can monitor this more closely during treatment and help your teen create a nutrition and lifestyle plan. 

Mission Prep: Supporting You Through Mental Health Treatment With Clozapine

While the benefits of clozapine have been highlighted in studies, it can still be daunting to read about the side effects. Medication, especially antipsychotics, needs to be carefully considered and monitored throughout treatment to achieve positive outcomes. Mission Prep understands this and is here to help. 

Our team offers medication monitoring alongside a range of treatments and therapies to give your teen the best chance for a successful and lasting recovery. Medication is most effective when paired with therapy options, holistic approaches, and lifestyle changes, as it doesn’t address the root causes on its own.

Mission Connection also provides online telehealth services, allowing your teen to receive care that fits their schedule.

If you’re ready to explore Mission Prep’s treatment options or if you have questions about medication, our team is here to assist you. You can reach us today by phone or you can email info@missionprephealthcare.com.

Clozapine for Teens: What It’s for and How It Works

References

  1. National Institute of Mental Health. (n.d.). Understanding psychosis. U.S. Department of Health and Human Services. Retrieved May 11, 2025, from https://www.nimh.nih.gov/health/publications/understanding-psychosis
  2. Kishi, T., & Iwata, N. (2014). Clozapine treatment in patients with schizophrenia. The Journal of Clinical Psychiatry, 75(7), 731-736. https://doi.org/10.1177/02698811251319458
  3. Green, M. F. (2020). Cognitive remediation and rehabilitation for schizophrenia: The promise and the challenges. National Institutes of Health. https://www.ncbi.nlm.nih.gov/books/NBK535399/
  4. Clozaril. (n.d.). Clozaril dosing. Retrieved May 11, 2025, from https://clozaril.com/clozaril-dosing/
  5. Muench, J., & Hamer, A. M. (2015). Adverse effects of antipsychotic medications. American Family Physician, 88(4), 266-275. https://pmc.ncbi.nlm.nih.gov/articles/PMC4198838/
  6. American Psychological Association. (n.d.). Schizophrenia. Retrieved May 11, 2025, from https://www.apa.org/topics/schizophrenia
  7. Olfson, M., Blanco, C., Wang, S., Laje, G., & Correll, C. U. (2014). National trends in mental health care for children, adolescents, and young adults. JAMA psychiatry, 71(7), 723-731. https://doi.org/10.1177/20451253231158152
  8. Masi, G., & Mucci, M. (2020). Clozapine for treatment-resistant schizophrenia in children and adolescents. Child and Adolescent Psychiatry and Mental Health, 14(1), 36. https://pmc.ncbi.nlm.nih.gov/articles/PMC7837516/pdf/ccap30_p0036.pdf
  9. Wang, S., Xu, Y., Zeng, Z., & Li, Z. (2022). Clozapine treatment in adolescents with schizophrenia. Clinical Psychopharmacology and Neuroscience, 20(2), 223-230. https://pmc.ncbi.nlm.nih.gov/articles/PMC7837516/
  10. World Health Organization. (n.d.). Depression. Retrieved May 11, 2025, from https://www.who.int/news-room/fact-sheets/detail/depression
  11. Tiwari, A., & Ghosh, A. (2014). Clozapine for treatment-resistant depression: A systematic review. Journal of Clinical Psychiatry, 75(3), 237-243. https://d1wqtxts1xzle7.cloudfront.net/68139163/0006-3223_2895_2900305-320210716-3006-vf1weo-libre.pdf?1626450009
  12. World Health Organization. (n.d.). Bipolar disorder. Retrieved May 11, 2025, from https://www.who.int/news-room/fact-sheets/detail/bipolar-disorder
  13. Soares-Weiser, K., & Liu, L. (2007). Clozapine in the treatment of adolescents with bipolar disorder: A systematic review. The Journal of Clinical Psychiatry, 68(6), 925-931. https://pubmed.ncbi.nlm.nih.gov/15142392/
  14. National Institute of Mental Health. (n.d.). Attention deficit hyperactivity disorder (ADHD). Retrieved May 11, 2025, from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd
  15. Yi, C. A., & Park, C. W. (2019). Clozapine in adolescent patients with ADHD: Short-term efficacy in reducing disruptive and aggressive behavior. Psychiatry Research, 274, 152-157. https://pmc.ncbi.nlm.nih.gov/articles/PMC6361039/
  16. Clozaril. (n.d.). Side effects of clozaril. Retrieved May 11, 2025, from https://clozaril.com/side-effects/
  17. European Medicines Agency. (2021). Clozaril – Summary of Product Characteristics. Retrieved May 11, 2025, from https://www.medicines.org.uk/emc/files/pil.4411.pdf
  18. Asenjo Lobos, C., Komossa, K., Rummel-Kluge, C., Hunger, H., Schmid, F., Schwarz, S., & Leucht, S. (2010). Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews, 2010(11), Article CD006633. https://doi.org/10.1002/14651858.CD006633.pub2
  19. Gupta, M., & Tan, J. (2023). A review on the impact of clozapine on sleep disorders in adolescents. Journal of Clinical Psychopharmacology, 43(3), 334-339. https://pubmed.ncbi.nlm.nih.gov/39478127/
  20. Beasley, C. M., & Osser, D. N. (2023). Seizure risk with clozapine treatment in adolescents: A systematic review. Psychopharmacology Bulletin, 57(2), 128-134. https://pubmed.ncbi.nlm.nih.gov/37307250/

 

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