Somatic treatment for depressive illnesses in children and adolescents

Electroconvulsive therapy and transcranial magnetic stimulation: can they be considered valid modalities in the treatment of pediatric mood disorders?

Depression in children and adolescents is a severe and debilitating disorder and can be life-endangering. Even when it is not life-endangering, however, it has a grave impact on the quality of life of youngsters and their families, and interferes with normal growth and development. In recent years, the field of child psychiatry has become more aware of the limited applicability of data from the adult literature to children and adolescents and the limited resources that child psychiatrists have in treating depression. This awareness substantiates the need to define the place of electroconvulsive therapy and transcranial magnetic stimulation in the treatment of pediatric depression.

A pilot controlled trial of topiramate for mania in children and adolescents with bipolar disorder

OBJECTIVE

To assess the efficacy of topiramate monotherapy for acute mania in children and adolescents with bipolar disorder type I.

METHOD

This double-blind, placebo-controlled study was discontinued early when adult mania trials with topiramate failed to show efficacy. Efficacy end points included the Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale for Children, Children's Depression Rating Scale, Children's Global Assessment Scale, and Clinical Global Impressions-Improvement.

RESULTS

Fifty-six children and adolescents (6-17 years) with a diagnosis of bipolar disorder type I received topiramate (n=29, 52%) or placebo (n=27, 48%). The only statistically significant differences in efficacy measures between treatment groups were the difference between slopes of the linear mean profiles of the YMRS (p=.003) using a post hoc repeated measures regression and the change in Brief Psychiatric Rating Scale for Children at day 28 (-14.9 versus-5.9, p=.048) using observed data. Adverse events with topiramate included decreased appetite, nausea, diarrhea, and paresthesia.

CONCLUSIONS

Topiramate was well tolerated; however, the results are inconclusive because of premature termination resulting in a limited sample size. Adequately powered controlled trials are necessary to determine whether topiramate has efficacy in reducing symptoms of acute mania in children and adolescents.