1
|
Hetrick SE, McKenzie JE, Bailey AP, Sharma V, Moller CI, Badcock PB, Cox GR, Merry SN, Meader N. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev 2021; 5:CD013674. [PMID: 34029378 PMCID: PMC8143444 DOI: 10.1002/14651858.cd013674.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Major depressive disorders have a significant impact on children and adolescents, including on educational and vocational outcomes, interpersonal relationships, and physical and mental health and well-being. There is an association between major depressive disorder and suicidal ideation, suicide attempts, and suicide. Antidepressant medication is used in moderate to severe depression; there is now a range of newer generations of these medications. OBJECTIVES To investigate, via network meta-analysis (NMA), the comparative effectiveness and safety of different newer generation antidepressants in children and adolescents with a diagnosed major depressive disorder (MDD) in terms of depression, functioning, suicide-related outcomes and other adverse outcomes. The impact of age, treatment duration, baseline severity, and pharmaceutical industry funding was investigated on clinician-rated depression (CDRS-R) and suicide-related outcomes. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR)), together with Ovid Embase, MEDLINE and PsycINFO till March 2020. SELECTION CRITERIA Randomised trials of six to 18 year olds of either sex and any ethnicity with clinically diagnosed major depressive disorder were included. Trials that compared the effectiveness of newer generation antidepressants with each other or with a placebo were included. Newer generation antidepressants included: selective serotonin reuptake inhibitors; selective norepinephrine reuptake inhibitors (SNRIs); norepinephrine reuptake inhibitors; norepinephrine dopamine reuptake inhibitors; norepinephrine dopamine disinhibitors (NDDIs); and tetracyclic antidepressants (TeCAs). DATA COLLECTION AND ANALYSIS Two reviewers independently screened titles/abstracts and full texts, extracted data, and assessed risk of bias. We analysed dichotomous data as Odds Ratios (ORs), and continuous data as Mean Difference (MD) for the following outcomes: depression symptom severity (clinician rated), response or remission of depression symptoms, depression symptom severity (self-rated), functioning, suicide related outcomes and overall adverse outcomes. Random-effects network meta-analyses were conducted in a frequentist framework using multivariate meta-analysis. Certainty of evidence was assessed using Confidence in Network Meta-analysis (CINeMA). We used "informative statements" to standardise the interpretation and description of the results. MAIN RESULTS Twenty-six studies were included. There were no data for the two primary outcomes (depressive disorder established via clinical diagnostic interview and suicide), therefore, the results comprise only secondary outcomes. Most antidepressants may be associated with a "small and unimportant" reduction in depression symptoms on the CDRS-R scale (range 17 to 113) compared with placebo (high certainty evidence: paroxetine: MD -1.43, 95% CI -3.90, 1.04; vilazodone: MD -0.84, 95% CI -3.03, 1.35; desvenlafaxine MD -0.07, 95% CI -3.51, 3.36; moderate certainty evidence: sertraline: MD -3.51, 95% CI -6.99, -0.04; fluoxetine: MD -2.84, 95% CI -4.12, -1.56; escitalopram: MD -2.62, 95% CI -5.29, 0.04; low certainty evidence: duloxetine: MD -2.70, 95% CI -5.03, -0.37; vortioxetine: MD 0.60, 95% CI -2.52, 3.72; very low certainty evidence for comparisons between other antidepressants and placebo). There were "small and unimportant" differences between most antidepressants in reduction of depression symptoms (high- or moderate-certainty evidence). Results were similar across other outcomes of benefit. In most studies risk of self-harm or suicide was an exclusion criterion for the study. Proportions of suicide-related outcomes were low for most included studies and 95% confidence intervals were wide for all comparisons. The evidence is very uncertain about the effects of mirtazapine (OR 0.50, 95% CI 0.03, 8.04), duloxetine (OR 1.15, 95% CI 0.72, 1.82), vilazodone (OR 1.01, 95% CI 0.68, 1.48), desvenlafaxine (OR 0.94, 95% CI 0.59, 1.52), citalopram (OR 1.72, 95% CI 0.76, 3.87) or vortioxetine (OR 1.58, 95% CI 0.29, 8.60) on suicide-related outcomes compared with placebo. There is low certainty evidence that escitalopram may "at least slightly" reduce odds of suicide-related outcomes compared with placebo (OR 0.89, 95% CI 0.43, 1.84). There is low certainty evidence that fluoxetine (OR 1.27, 95% CI 0.87, 1.86), paroxetine (OR 1.81, 95% CI 0.85, 3.86), sertraline (OR 3.03, 95% CI 0.60, 15.22), and venlafaxine (OR 13.84, 95% CI 1.79, 106.90) may "at least slightly" increase odds of suicide-related outcomes compared with placebo. There is moderate certainty evidence that venlafaxine probably results in an "at least slightly" increased odds of suicide-related outcomes compared with desvenlafaxine (OR 0.07, 95% CI 0.01, 0.56) and escitalopram (OR 0.06, 95% CI 0.01, 0.56). There was very low certainty evidence regarding other comparisons between antidepressants. AUTHORS' CONCLUSIONS Overall, methodological shortcomings of the randomised trials make it difficult to interpret the findings with regard to the efficacy and safety of newer antidepressant medications. Findings suggest that most newer antidepressants may reduce depression symptoms in a small and unimportant way compared with placebo. Furthermore, there are likely to be small and unimportant differences in the reduction of depression symptoms between the majority of antidepressants. However, our findings reflect the average effects of the antidepressants, and given depression is a heterogeneous condition, some individuals may experience a greater response. Guideline developers and others making recommendations might therefore consider whether a recommendation for the use of newer generation antidepressants is warranted for some individuals in some circumstances. Our findings suggest sertraline, escitalopram, duloxetine, as well as fluoxetine (which is currently the only treatment recommended for first-line prescribing) could be considered as a first option. Children and adolescents considered at risk of suicide were frequently excluded from trials, so that we cannot be confident about the effects of these medications for these individuals. If an antidepressant is being considered for an individual, this should be done in consultation with the child/adolescent and their family/caregivers and it remains critical to ensure close monitoring of treatment effects and suicide-related outcomes (combined suicidal ideation and suicide attempt) in those treated with newer generation antidepressants, given findings that some of these medications may be associated with greater odds of these events. Consideration of psychotherapy, particularly cognitive behavioural therapy, as per guideline recommendations, remains important.
Collapse
Affiliation(s)
- Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders, The University of Auckland, Auckland, New Zealand
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alan P Bailey
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Vartika Sharma
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders, The University of Auckland, Auckland, New Zealand
| | - Carl I Moller
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Paul B Badcock
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Georgina R Cox
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Sally N Merry
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Nicholas Meader
- Centre for Reviews and Dissemination, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| |
Collapse
|
2
|
Schwartz BS, Glass TA, Pollak J, Hirsch AG, Bailey-Davis L, Moran T, Bandeen-Roche K. Depression, its comorbidities and treatment, and childhood body mass index trajectories. Obesity (Silver Spring) 2016; 24:2585-2592. [PMID: 27804225 PMCID: PMC5125866 DOI: 10.1002/oby.21627] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE No prior studies have evaluated depression diagnoses and cumulative antidepressant use in relation to longitudinal body mass index (BMI) trajectories in a population-representative sample. METHODS Electronic health record data from 105,163 children ages 8 to 18 years with 314,648 BMI values were used. Depression diagnoses were evaluated as ever versus never, cumulative number of encounters with diagnoses, and total duration of diagnoses. Antidepressants were evaluated as months of use. Associations were evaluated with diagnoses alone, antidepressants alone, and then together, adjusting for covariates. RESULTS A total of 6,172 (5.9%) and 10,628 (10.1%) children had a diagnosis of depression or received antidepressant treatment, respectively. At all ages, children receiving Medical Assistance (30.9%) were more likely to be treated with antidepressants. Depression diagnosis and antidepressant use were each independently and positively associated with BMI trajectories; associations were stronger with longer durations of diagnosis and treatment. Among children who received 12 or more months of antidepressants (vs. none), the mean (95% CI) weight gain at 18 years associated with antidepressant use (all classes) was 2.10 (1.76-2.45) kg. CONCLUSIONS Depression and antidepressant use were both independently associated with increasing BMIs over time, suggesting an important unintended consequence of healthcare to the obesity epidemic.
Collapse
Affiliation(s)
- Brian S. Schwartz
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Center for Health Research, Geisinger Health System, Danville, PA
| | - Thomas A. Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jonathan Pollak
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Timothy Moran
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
3
|
Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN. Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database Syst Rev 2012; 11:CD004851. [PMID: 23152227 PMCID: PMC8786271 DOI: 10.1002/14651858.cd004851.pub3] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Depressive disorders are common in young people and are associated with significant negative impacts. Newer generation antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are often used, however evidence of their effectiveness in children and adolescents is not clear. Furthermore, there have been warnings against their use in this population due to concerns about increased risk of suicidal ideation and behaviour. OBJECTIVES To determine the efficacy and adverse outcomes, including definitive suicidal behaviour and suicidal ideation, of newer generation antidepressants compared with placebo in the treatment of depressive disorders in children and adolescents. SEARCH METHODS For this update of the review, we searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to October 2011. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (the Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974 -), MEDLINE (1950 -) and PsycINFO (1967 -). We searched clinical trial registries and pharmaceutical company websites. We checked reference lists of included trials and other reviews, and sent letters to key researchers and the pharmaceutical companies of included trials from January to August 2011. SELECTION CRITERIA Published and unpublished randomised controlled trials (RCTs), cross-over trials and cluster trials comparing a newer generation antidepressant with a placebo in children and adolescents aged 6 to 18 years old and diagnosed with a depressive disorder were eligible for inclusion. In this update, we amended the selection criteria to include newer generation antidepressants rather than SSRIs only. DATA COLLECTION AND ANALYSIS Two or three review authors selected the trials, assessed their quality, and extracted trial and outcome data. We used a random-effects meta-analysis. We used risk ratio (RR) to summarise dichotomous outcomes and mean difference (MD) to summarise continuous measures. MAIN RESULTS Nineteen trials of a range of newer antidepressants compared with placebo, containing 3335 participants, were included. The trials excluded young people at high risk of suicide and many co-morbid conditions and the participants are likely to be less unwell than those seen in clinical practice. We judged none of these trials to be at low risk of bias, with limited information about many aspects of risk of bias, high drop out rates and issues regarding measurement instruments and the clinical usefulness of outcomes, which were often variously defined across trials. Overall, there was evidence that those treated with an antidepressant had lower depression severity scores and higher rates of response/remission than those on placebo. However, the size of these effects was small with a reduction in depression symptoms of 3.51 on a scale from 17 to 113 (14 trials; N = 2490; MD -3.51; 95% confidence interval (CI) -4.55 to -2.47). Remission rates increased from 380 per 1000 to 448 per 1000 for those treated with an antidepressant. There was evidence of an increased risk (58%) of suicide-related outcome for those on antidepressants compared with a placebo (17 trials; N = 3229; RR 1.58; 95% CI 1.02 to 2.45). This equates to an increased risk in a group with a median baseline risk from 25 in 1000 to 40 in 1000. Where rates of adverse events were reported, this was higher for those prescribed an antidepressant. There was no evidence that the magnitude of intervention effects (compared with placebo) were modified by individual drug class. AUTHORS' CONCLUSIONS Caution is required in interpreting the results given the methodological limitations of the included trials in terms of internal and external validity. Further, the size and clinical meaningfulness of statistically significant results are uncertain. However, given the risks of untreated depression in terms of completed suicide and impacts on functioning, if a decision to use medication is agreed, then fluoxetine might be the medication of first choice given guideline recommendations. Clinicians need to keep in mind that there is evidence of an increased risk of suicide-related outcomes in those treated with antidepressant medications.
Collapse
Affiliation(s)
- Sarah E Hetrick
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | | | | | | | | |
Collapse
|
4
|
Dell ML. Child and adolescent depression: psychotherapeutic, ethical, and related nonpharmacologic considerations for general psychiatrists and others who prescribe. Psychiatr Clin North Am 2012; 35:181-201. [PMID: 22370498 DOI: 10.1016/j.psc.2011.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Depression is a common, recurring disorder affecting millions of youth at some point before they reach mature adulthood. Given the shortage of and uneven distribution of psychiatrists who have completed specialized fellowships in child and adolescent psychiatry, a significant number of depressed youth will receive their pharmacotherapy from general psychiatrists and other prescribers with varying degrees of interest, training, and even willingness to treat children and adolescents. For general psychiatrists who will prescribe antidepressants for minors, knowledge of the training and expertise of nonphysician mental health professionals, the psychotherapies they may employ, and familiarity with school services are essential. Physicians who typically work only with adults will also need familiarity with differing ethical, legal, and regulatory issues and standards applicable to pediatric psychopharmacology. General psychiatrists, pediatricians, family physicians, nurse practitioners, and others contribute greatly to the care of depressed children, adolescents, and their families, and many find this work to be a very rewarding part of their professional practices.
Collapse
Affiliation(s)
- Mary Lynn Dell
- Case Western Reserve University School of Medicine, 10524 Euclid Avenue, W.O. Walker Building, Suite 1155A, Cleveland, OH 44106, USA.
| |
Collapse
|
5
|
Jerrell JM, McIntyre RS, Tripathi A. Childhood treatment with psychotropic medication and development of comorbid medical conditions in adolescent-onset bipolar disorder. Hum Psychopharmacol 2011; 26:451-9. [PMID: 21898598 DOI: 10.1002/hup.1227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 07/12/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aims to investigate the association between early treatment with psychotropic medications and the development of medical comorbidities in pediatric patients who develop bipolar disorder (BD). METHODS Data from the South Carolina Medicaid program covering all medical services and medication prescriptions between January 1996 and December 2005 were used to determine the association between childhood exposure to psychotropic medications (i.e., psychostimulants, antidepressants, and antipsychotics) and the diagnosis of select comorbid medical conditions in 1841 children and adolescents diagnosed with Diagnostic and Statistical Manual IV defined BD. RESULTS In separate regressions controlling for all psychotropic medications prescribed and all comorbid medical conditions diagnosed prior to the BD, hypertension and cardiovascular disorders were more likely in those prescribed second generation antipsychotics or psychostimulants, whereas obesity/overweight was more likely in those taking serotonin norepinephrine reuptake inhibitor/heterocyclic antidepressants, and asthma was more likely in those taking selective serotonin reuptake inhibitors. CONCLUSION Childhood cardiometabolic events appear to be systematically associated with specific classes of psychotropic medications, but no innate, developmental sequencing of cardiometabolic abnormalities was apparent before early adolescence in patients subsequently diagnosed and treated for BD.
Collapse
Affiliation(s)
- Jeanette M Jerrell
- Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
| | | | | |
Collapse
|
6
|
Jerrell JM, McIntyre RS. Metabolic, digestive, and reproductive adverse events associated with antimanic treatment in children and adolescents: a retrospective cohort study. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 21085553 DOI: 10.4088/pcc.09m00891ora] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 10/26/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify factors associated with incident metabolic and reproductive adverse events in children and adolescents. METHOD A retrospective cohort design evaluating Medicaid medical and pharmacy claims made in South Carolina between January 1996 and December 2005 was employed for 3,657 children and adolescents (aged 17 years old and younger) prescribed 1 of 3 antimanic medications (ie, lithium, carbamazepine, or valproic acid derivatives) and a random sample of 4,500 children and adolescents not treated with psychotropic medications. RESULTS Compared to the control sample, the treated cohort was more likely to be diagnosed with obesity/weight gain (odds ratio [OR] = 1.89), type 2 diabetes mellitus (OR = 2.50), dyslipidemia (OR = 1.89), nausea (OR = 1.61), anorexia (OR = 3.85), and sexual/reproductive adverse events (OR = 2.04). Within the treated cohort, incident dyslipidemia was more likely for those prescribed carbamazepine (OR = 1.52) compared to valproate and coprescribed antipsychotics (OR = 1.47) or selective serotonin reuptake inhibitors (SSRIs) (OR = 1.49) compared to those not taking antipsychotics or taking serotonin-norepinephrine reuptake inhibitor/heterocyclic (SNRI/other) antidepressants. The odds of developing nausea/vomiting were higher for those prescribed carbamazepine (OR = 1.70) or lithium (OR = 1.49) compared to valproate, and those coprescribed psychostimulants (OR = 1.25) compared to those not taking psychostimulants. The odds of developing obesity/weight gain and type 2 diabetes mellitus were higher for those coprescribed SSRIs (ORs = 1.72, 2.58) or antipsychotics (ORs = 1.69, 1.77) compared to those taking SNRI/other antidepressants or not taking antipsychotics. Incident sexual/reproductive adverse events were more likely for those coprescribed SSRIs (OR = 2.02) compared to those taking SNRI/other antidepressants. CONCLUSION Commonly employed psychotropic agents are associated with clinically significant metabolic, digestive, and reproductive-related adverse events. Treatment decisions in young populations are usefully informed by the somatic consequences of the medication options.
Collapse
Affiliation(s)
- Jeanette M Jerrell
- Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USA.
| | | |
Collapse
|
7
|
Jerrell JM. Adverse Events Associated With Psychotropic Treatment in African American Children and Adolescents. J Natl Med Assoc 2010; 102:375-83. [DOI: 10.1016/s0027-9684(15)30572-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
Jerrell JM. Neuroendocrine-related adverse events associated with antidepressant treatment in children and adolescents. CNS Neurosci Ther 2009; 16:83-90. [PMID: 19769598 DOI: 10.1111/j.1755-5949.2009.00106.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
There is only limited community-based practice safety information available regarding antidepressant use in pediatric patients. This study identifies the factors associated with incident neuroendocrine-related metabolic, digestive, and sexual/reproductive adverse events in children and adolescents treated with antidepressants. A retrospective cohort design evaluating Medicaid medical and pharmacy claims between January, 1996 and December, 2005 was employed for 11970 children and adolescents prescribed an antidepressant medication, and a random sample of 4500 children not treated with psychotropic medications. Incident obesity/weight gain, Type 2 diabetes mellitus, and dyslipidemia were more likely for those prescribed selective serotonin reuptake inhibitors (SSRIs) (OR = 1.49; 1.37; 1.44), whereas Type 2 diabetes mellitus and dyslipidemia were more likely for those prescribed weight-inducing antidepressants (ORs = 1.26; 1.24), and those with pre-existing endocrinopathies (ORs = 3.96; 1.90), controlling for the effects of co-prescribed mood stabilizers or antipsychotics. Incident nausea/vomiting was less likely for those taking SSRIs (OR = 0.78). Females and children under 12 years of age were more likely to develop these adverse effects. Practitioners need to carefully consider the neuroendocrine- related adverse effects of SSRI antidepressant agents in particular, especially in individuals with comorbid endocrine conditions, and those co-prescribed other classes of psychotropic medications.
Collapse
Affiliation(s)
- Jeanette M Jerrell
- Professor of Neuropsychiatry, University of South Carolina School of Medicine, Columbia, South Carolina 29203, USA.
| |
Collapse
|
9
|
Jerrell JM, McIntyre RS. Cardiovascular and neurological adverse events associated with antidepressant treatment in children and adolescents. J Child Neurol 2009; 24:297-304. [PMID: 19258288 DOI: 10.1177/0883073808323523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A retrospective cohort design of Medicaid medical and pharmacy claims for 1996 through 2005 was employed for 14,171 children and adolescents prescribed an antidepressant medication and a random sample of 4500 children not treated with any class of psychotropic medication to compare the prevalence rates of cardiovascular and neurological adverse events. The treated cohort evinced a higher prevalence of cardiovascular events, orthostatic hypotension, seizures, insomnia, and headaches. In the treated cohort, patients were at a significantly higher risk for incident cardiovascular events when exposed to selective serotonin reuptake inhibitors and weight-inducing antidepressants, mood stabilizers, and antipsychotics. Incident orthostatic hypotension was associated with weight-inducing antidepressants and mood stabilizers. Incident seizures and extrapyramidal symptoms were unrelated to antidepressant or co-prescribed psychotropic medications, but both were significantly associated with comorbid central nervous system, organic brain/mental retardation, or preexisting cardiovascular or cerebrovascular conditions. Headaches and dizziness were significantly related to taking mood stabilizers.
Collapse
Affiliation(s)
- Jeanette M Jerrell
- Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, South Carolina 29203, USA.
| | | |
Collapse
|
10
|
Cohen D, Deniau E, Maturana A, Tanguy ML, Bodeau N, Labelle R, Breton JJ, Guile JM. Are child and adolescent responses to placebo higher in major depression than in anxiety disorders? A systematic review of placebo-controlled trials. PLoS One 2008; 3:e2632. [PMID: 18612460 PMCID: PMC2435626 DOI: 10.1371/journal.pone.0002632] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 06/03/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In a previous report, we hypothesized that responses to placebo were high in child and adolescent depression because of specific psychopathological factors associated with youth major depression. The purpose of this study was to compare the placebo response rates in pharmacological trials for major depressive disorder (MDD), obsessive compulsive disorder (OCD) and other anxiety disorders (AD-non-OCD). METHODOLOGY AND PRINCIPAL FINDINGS We reviewed the literature relevant to the use of psychotropic medication in children and adolescents with internalized disorders, restricting our review to double-blind studies including a placebo arm. Placebo response rates were pooled and compared according to diagnosis (MDD vs. OCD vs. AD-non-OCD), age (adolescent vs. child), and date of publication. From 1972 to 2007, we found 23 trials that evaluated the efficacy of psychotropic medication (mainly non-tricyclic antidepressants) involving youth with MDD, 7 pertaining to youth with OCD, and 10 pertaining to youth with other anxiety disorders (N = 2533 patients in placebo arms). As hypothesized, the placebo response rate was significantly higher in studies on MDD, than in those examining OCD and AD-non-OCD (49.6% [range: 17-90%] vs. 31% [range: 4-41%] vs. 39.6% [range: 9-53], respectively, ANOVA F = 7.1, p = 0.002). Children showed a higher stable placebo response within all three diagnoses than adolescents, though this difference was not significant. Finally, no significant effects were found with respect to the year of publication. CONCLUSION MDD in children and adolescents appears to be more responsive to placebo than other internalized conditions, which highlights differential psychopathology.
Collapse
Affiliation(s)
- David Cohen
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, GH Pitié-Salpétrière, AP-HP, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
McHenry LB, Jureidini JN. Industry-Sponsored Ghostwriting in Clinical Trial Reporting: A Case Study. Account Res 2008; 15:152-67. [DOI: 10.1080/08989620802194384] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Leemon B. McHenry
- a Department of Philosophy , California State University , Northridge, Northridge, California, USA
| | - Jon N. Jureidini
- b Discipline of Psychiatry , University of Adelaide , Adelaide, South Australia
| |
Collapse
|
12
|
Tao R, Moore JK, Mayes TL, Emslie GJ. Depression in children and adolescents: optimizing treatment. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/17455111.1.2.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Depression is a severe and prevalent illness among children and adolescents. Recent controversies regarding antidepressant use among pediatric patients have left healthcare providers, particularly primary-care providers, feeling uncertain of how to approach the care of depressed pediatric patients. Several large-scale studies of the treatment of pediatric depression have been completed. In addition, substantial progress has been made in our understanding of benefit versus risk in the treatment of pediatric depression. This paper presents the most updated scientific evidence in pediatric depression treatment. The review covers a wide range of treatment modalities including psychotherapy, antidepressant and alternative remedies. Recommendations based on both the scientific evidence and the most current guidelines and treatment algorithms are outlined.
Collapse
Affiliation(s)
- Rongrong Tao
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Jarrette K Moore
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Taryn L Mayes
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Graham J Emslie
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| |
Collapse
|
13
|
Hirsch AJ, Carlson JS. Prescription Practices and Empirical Efficacy of Psychopharmacologic Treatments for Pediatric Major Depressive Disorder. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2007; 20:222-33. [DOI: 10.1111/j.1744-6171.2007.00104.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Hetrick S, Merry S, McKenzie J, Sindahl P, Proctor M. Selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in children and adolescents. Cochrane Database Syst Rev 2007:CD004851. [PMID: 17636776 DOI: 10.1002/14651858.cd004851.pub2] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Depressive disorders are common in young people and are associated with significant negative impacts. Selective serotonin reuptake inhibitors (SSRIs) are often used, however, evidence of their effectiveness in children and adolescents is not clear. Furthermore, there have been warnings against their use in this population due to concerns about increased risk of suicidal ideation and behaviour. OBJECTIVES To determine the efficacy and adverse outcomes, including definitive suicidal behaviour and suicidal ideation, of SSRIs compared to placebo in the treatment of depressive disorders in children and adolescents. SEARCH STRATEGY We searched the CCDAN Trials Register, MEDLINE, PSYCHINFO and CENTRAL. Reference lists were checked, letters were sent to key researchers and internet databases searched. SELECTION CRITERIA We included published and unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS Two or three review authors selected the trials, assessed the quality and extracted trial and outcome data. We used a fixed-effect meta-analysis. The relative risk was used to summarise dichotomous outcomes and the mean difference to summarise continuous measures. MAIN RESULTS Twelve trials were eligible for inclusion, with ten providing usable data. At 8-12 weeks, there was evidence that children and adolescents 'responded' to treatment with SSRIs (RR 1.28, 95% CI 1.17 to 1.41). There was also evidence of an increased risk of suicidal ideation and behaviour for those prescribed SSRIs (RR 1.80, 95% CI 1.19 to 2.72). Fluoxetine was the only SSRI where there was consistent evidence from three trials that it was effective in reducing depression symptoms in both children and adolescents (CDRS-R treatment effect -5.63, 95% CI -7.38 to -3.88), and 'response' to treatment (RR 1.86, 95% CI 1.49 to 2.32). Where rates of adverse events were reported, this was higher for those prescribed SSRIs. AUTHORS' CONCLUSIONS Caution is required to interpret the results. First, there were methodological issues, including high attrition, issues regarding measurement instruments and clinical usefulness of outcomes, often variously defined across trials. Second, patients seen in clinical practice are likely to be more unwell, and at greater risk of suicide, compared to those in the trials, and it is unclear how this group would respond to SSRIs. This needs to be considered, along with the evidence of an increased risk of suicide related outcomes in those treated with SSRIs. It is unclear what the effect of SSRIs is on suicide completion. While untreated depression is associated with the risk of completed suicide and impacts on functioning, it is unclear whether SSRIs would modify this risk in a clinically meaningful way.
Collapse
Affiliation(s)
- S Hetrick
- ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Locked Bag 10, 35 Poplar Road, Parkville, Melbourne, Victoria, Australia, 3054.
| | | | | | | | | |
Collapse
|
15
|
Perisse D, Gerardin P, Cohen D, Flament M, Mazet P. Le trouble des conduites chez l'enfant et l'adolescent : une revue des abords thérapeutiques. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.neurenf.2005.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
16
|
Kuo ES, Stoep AV, Stewart DG. Using the short mood and feelings questionnaire to detect depression in detained adolescents. Assessment 2006; 12:374-83. [PMID: 16244118 DOI: 10.1177/1073191105279984] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Mood and Feelings Questionnaire (MFQ) is examined for its utility in screening youth in juvenile justice settings for depression. In a cross-sectional study conducted at King County Juvenile Detention Center, a representative sample of 228 detained adolescents complete structured assessments, including the MFQ and the Massachusetts Youth Screening Instrument. Fifty youth also complete the Voice-Diagnostic Interview Schedule for Children. Internal reliability coefficient for the MFQ short form (SMFQ) is = .87. Factor analysis produces a unifactorial scale with item loadings of .43 to .78. At SMFQ cutoff > or = 10, sensitivity and specificity are optimized at 1.00/0.79. Prevalence of major depressive disorder is estimated at 32.1% (95% Confidence Interval = 25.3% to 39.2%). The SMFQ shows potential for depression screening of detained adolescents.
Collapse
|
17
|
Hollon SD, Garber J, Shelton RC. Treatment of depression in adolescents with cognitive behavior therapy and medications: A commentary on the TADS project. COGNITIVE AND BEHAVIORAL PRACTICE 2005. [DOI: 10.1016/s1077-7229(05)80019-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Kubiszyn T, Carlson JS, DeHay T. Pediatric Psychopharmacology for Prepubertal Internalizing Disorders. SCHOOL PSYCHOLOGY QUARTERLY 2005. [DOI: 10.1521/scpq.20.2.135.66513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
19
|
Conduct disorder and other disruptive behaviors: Pediatric psychopharmacology. ACTA ACUST UNITED AC 2004. [DOI: 10.1007/bf02629429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|