1
|
Bailly D. Benefits and risks of using antidepressants in children and adolescents. Expert Opin Drug Saf 2008; 7:9-27. [DOI: 10.1517/14740338.7.1.9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Daniel Bailly
- Service hospitalo-universitaire de psychiatrie, Hôpital Sainte-Marguerite, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France ;
| |
Collapse
|
2
|
Duffy A, Alda M, Milin R, Grof P. A consecutive series of treated affected offspring of parents with bipolar disorder: is response associated with the clinical profile? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:369-76. [PMID: 17696023 DOI: 10.1177/070674370705200606] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In adults with established bipolar disorder (BD), differential response to mood stabilizers has been associated with the clinical profile. Long-term treatment studies of youth with BD are lacking. This paper provides longitudinal observations of response to mood stabilizers early in the course of illness in youth with BD. METHOD We report on 15 research patients who, as adolescents, met DSM-IV lifetime criteria for a bipolar spectrum disorder and required long-term treatment. These youths derived from families with one parent having BD whose course and long-term treatment response were determined in accordance with research criteria. The patients were offered lithium, and if they failed to respond or refused it, they were treated with either an anticonvulsant or an atypical antipsychotic. Using a validated scale, an independent rater retrospectively blindly scored the response to long-term treatment. RESULTS Those patients who stabilized on lithium derived from lithium-responsive families, whereas those who stabilized on an antipsychotic derived from lithium-nonresponsive families. The clinical course in the youths stabilized by lithium differed from that in the youths stabilized by an atypical antipsychotic. CONCLUSIONS Our findings suggest that the clinical profile may help in selecting effective stabilizing treatment and that a proportion of youth can be stabilized on monotherapy. This is a small case series with nonrandom treatment assignment, and the findings should be considered tentative.
Collapse
Affiliation(s)
- Anne Duffy
- Department of Psychiatry, McGill University, Montreal, Quebec.
| | | | | | | |
Collapse
|
3
|
Papanikolaou K, Richardson C, Pehlivanidis A, Papadopoulou-Daifoti Z. Efficacy of antidepressants in child and adolescent depression: a meta-analytic study. J Neural Transm (Vienna) 2005; 113:399-415. [PMID: 16075184 DOI: 10.1007/s00702-005-0340-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2004] [Accepted: 05/21/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine whether antidepressant drugs are superior to placebo in the treatment of juvenile depression. METHOD Extensive literature search was done to retrieve all randomised controlled and all uncontrolled trials describing children and adolescents with a diagnosis of depression who underwent any antidepressant drug treatment. In order to combine results, separate analyses using random effect models were conducted first for controlled and then for both controlled and open studies. RESULTS 18 controlled and 23 open trials were submitted to meta-analysis. Tricyclics showed no significant benefit over placebo. Odds ratios for SSRIs were 1.84 (95% CI 1.35-2.50) for controlled and 1.83 (95% CI 1.40-2.40) for controlled and uncontrolled studies suggesting a significant benefit over placebo. Combining all antidepressants also gave confidence interval excluding the value one. CONCLUSIONS Despite some promising data concerning the use of SSRIs in the treatment of adolescent depression, caution is warranted until the long-term safety of these agents can be demonstrated. Insufficient data are available to judge even the short term merits of these agents in prepubertal children. There is no evidence to support the use of tricyclics in this population.
Collapse
Affiliation(s)
- K Papanikolaou
- Department of Child Psychiatry, University of Athens, Agia Sophia Children's Hospital, Athens, Greece.
| | | | | | | |
Collapse
|
4
|
Haapasalo-Pesu KM, Vuola T, Lahelma L, Marttunen M. Mirtazapine in the treatment of adolescents with major depression: an open-label, multicenter pilot study. J Child Adolesc Psychopharmacol 2004; 14:175-84. [PMID: 15319015 DOI: 10.1089/1044546041649110] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This multicenter, open-label study with a duration of 85 days was performed to evaluate the antidepressant efficacy and safety of mirtazapine (dose range, 30-45 mg) in 12-18-year-old adolescents diagnosed with major depression. Twenty-four (24) patients (15 female patients and 9 male patients) meeting the DSM-IV criteria for major depression and the Hamilton Rating Scale for Depression (HAM-D-17) score of 18 at baseline were enrolled in the study. The primary outcome measures were HAM-D-17, Beck Depression Inventory (BDI), and Clinical Global Impression (CGI) scales. Any changes in symptoms of anxiety were measured using the Hamilton Anxiety Rating Scale (HAM-A). The average age of the 23 subjects, who were eligible for analysis, was 16.3 years (standard deviation (SD) 6.11, median 17.3). The mean daily dose of mirtazapine was 32.9 mg. Mirtazapine showed a marked efficacy on all rating scales and was well tolerated. Mirtazapine had a beneficial effect on sleep. A rapid onset of sleep and pattern of action was seen. No dropouts due to adverse events were recorded. The most common treatment-emergent adverse events were tiredness, increased appetite, and dizziness. The results of this study suggest that mirtazapine may be an effective treatment for major depression in adolescents.
Collapse
|
5
|
Michael KD, Crowley SL. How effective are treatments for child and adolescent depression? A meta-analytic review. Clin Psychol Rev 2002; 22:247-69. [PMID: 11806021 DOI: 10.1016/s0272-7358(01)00089-7] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We located a comprehensive sample of studies (1980-1999) on the psychosocial and pharmacological treatment of child and adolescent depression through an extensive literature search. Articles that met the inclusionary criteria were subsequently analyzed. The outcome data from 38 studies were extracted and converted into effect sizes (ESs). Comparisons of main effects, demographic, and quality of study variables were conducted. The overall findings of this meta-analysis indicate that several different psychosocial interventions for child and adolescent depression produced moderate to large treatment gains that were clinically meaningful for many afflicted youth. However, in general, the vast majority of pharmacological interventions were not effective in treating depressed children and adolescents. Nonetheless, there is recent evidence that selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine are efficacious, and will likely play an increased role in the management of affective illness in youngsters. The clinical implications and limitations of these data are discussed and suggestions for future research are provided.
Collapse
|
6
|
|
7
|
Zito JM, Safer DJ. Antidepressant treatment in children and adolescents: bridging the gap between efficacy and effectiveness. Curr Psychiatry Rep 2001; 3:115-25. [PMID: 11276406 DOI: 10.1007/s11920-001-0008-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review of antidepressant treatments in children and adolescents emphasizes the gap between efficacy data derived from randomized clinical trials (RCTs) and the limited effectiveness data from community-based practices. Part one is a brief review of data from randomized, double-blind clinical trials to assess the evidence base for the major approved indications for antidepressants in youths. Part two reviews information gaps in the evidence from RCTs. Part three discusses nonexperimental evidence of the use of antidepressants, including surveys of prescription sales, physician surveys, and population-based data. Part four presents a comprehensive model for assessing the use of antidepressants in youths in the community. The model aims to answer a range of public health-oriented questions and is intended to improve treating physicians' and clinical care providers' ability to manage medications for optimal patient benefit. Suggestions are made for engaging health service providers, health insurers, academicians, advocates, and the government in building the necessary infrastructure to make effectiveness as vital as efficacy to the model of drug therapy evaluation.
Collapse
Affiliation(s)
- J M Zito
- University of Maryland, School of Pharmacy, Baltimore, MD 21201, USA. jzito@rx. umaryland.edu
| | | |
Collapse
|
8
|
Wagner KD, Ambrosini PJ. Childhood depression: pharmacological therapy/treatment (pharmacotherapy of childhood depression). JOURNAL OF CLINICAL CHILD PSYCHOLOGY 2001; 30:88-97. [PMID: 11294082 DOI: 10.1207/s15374424jccp3001_10] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Critiqued the published double-blind, placebo-controlled studies of antidepressant pharmacotherapy in child and adolescent major depressive disorder to assess their overall efficacy. The pharmacological mechanism of antidepressant action also was discussed. At best, antidepressant treatment for depressed youths is only modestly effective. In particular, the tricyclic antidepressants are not superior to placebo; however, early evidence with the selective serotonin reuptake inhibitors is more encouraging. The theoretical basis for this response pattern is discussed from a methodological perspective, from a neurodevelopmental status, and from a biological viewpoint. Study modifications are suggested which could improve some of the methodological limitations apparent in previous clinical drug trials.
Collapse
|
9
|
Abstract
Major depression is a common disorder during childhood and adolescence. Over the past decade, many new antidepressants have been marketed in the US. In adults, these newer agents have been shown to be as effective as the prototypic tricyclic antidepressants (TCAs). Further, when compared with the TCAs these medications are better tolerated and are safer in overdose. Although TCAs are effective in the treatment of depressed adults, controlled clinical trials have not demonstrated their efficacy in either children or adolescents. In addition, concerns about the safety of TCAs and the monoamine oxidase inhibitors has left disappointingly few pharmacological treatment options available for depressed children and adolescents. For this reason, clinicians have begun to prescribe the newer agents for this population, despite the fact that relatively little is known about their disposition, safety or effectiveness in the young. Investigators have begun to examine whether the use of newer antidepressant medications such as fluoxetine, sertraline, paroxetine, fluvoxamine, nefazodone, and venlafaxine is truly indicated for children and adolescents with major depression. Pharmacokinetic studies of sertraline, paroxetine and nefazodone have been performed in depressed youths. The results of these studies have provided data for rational administration strategies for these agents. They have also provided evidence that these agents may be well tolerated in children and adolescents. Further evidence that these agents are often well tolerated when prescribed to depressed youths has been obtained from both open-label and double-blind studies. Published studies have generally shown that open-label treatment with these newer agents often leads to symptom amelioration in paediatric patients with major depression. Since high rates of placebo response are often seen in depressed children and adolescents, results from these studies cannot be interpreted to suggest that these medications have true antidepressant efficacy in this population. At present, the results of only two such studies have been published. The results of one of these trials are difficult to interpret because of methodological considerations. The other study reported that treatment with fluoxetine was superior to placebo. This paper critically reviews what has been published about the pharmacological treatment of depressed paediatric patients and provides some guidance to the use of antidepressants in this patient population, paying particular attention to what is known about the newer antidepressants as well as considering directions for future research.
Collapse
Affiliation(s)
- R L Findling
- Child and Adolescent Psychiatry, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Ohio 44106-5080, USA
| | | | | |
Collapse
|
10
|
Abstract
Many therapeutic approaches to managing suicidal behavior among youth have been used, including in-school education programs, screening programs, telephone hotlines, cognitive behavioral therapies, medication management, and inpatient milieux treatment programs. These interventions have been applied based on educational and therapeutic principles drawn from prior work with adolescents in varied scholastic and psychiatric settings. This article reviews: the assessment of risk factors among suicide attempters, emotional states, family, social isolation, interpersonal loss, substance and alcohol abuse, and treatment strategies.
Collapse
Affiliation(s)
- L L Greenhill
- Division of Child and Adolescent Psychiatry, Columbia College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | |
Collapse
|
11
|
Abstract
This article is concerned with issues pertaining to the degree to which clinical therapeutic decisions can reasonably depart from the best available scientific data. There is a tension between the traditions of practitioner autonomy and the boundaries set by research findings. Ambiguity exists as to how much freedom practitioners have to accept or reject the existing scientific paradigm. The nature of the dilemma is explored by analyzing the current problems confronting child psychiatrists and pediatricians who choose to treat depressed children with antidepressants. Despite unanimous literature of double-blind studies indicating that antidepressants are no more effective than placebos in treating depression in children and adolescents, such medications continue to be in wide use. The strategies used to resolve this sort of contradiction are considered, and certain ethical puzzles are appraised.
Collapse
Affiliation(s)
- R L Fisher
- Department of Psychiatry, State University of New York, Syracuse, 13210, USA
| | | |
Collapse
|
12
|
Kaminski KM, Naylor MW, King CA, Ghazuiddin N. Reactive mood and atypical depression in psychiatrically hospitalized depressed adolescents. ACTA ACUST UNITED AC 1995. [DOI: 10.1002/depr.3050030404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
13
|
Kutcher S, Boulos C, Ward B, Marton P, Simeon J, Ferguson HB, Szalai J, Katic M, Roberts N, Dubois C. Response to desipramine treatment in adolescent depression: a fixed-dose, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry 1994; 33:686-94. [PMID: 8056732 DOI: 10.1097/00004583-199406000-00010] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the efficacy and tolerability of the tricyclic antidepressant desipramine (DMI) in the treatment of DSM-III-R-diagnosed major depressive disorder in adolescents. METHOD Sixty adolescents (42 female, 18 male; aged 15 to 19 years) diagnosed with major depressive disorder using clinical interview and Schedule for Affective Disorders and Schizophrenia for School-Age Children were randomized to receive either DMI (200 mg daily in divided doses) or placebo for six consecutive weeks following a 1-week placebo period. Treatment outcome was determined using the Hamilton Depression Rating Scale and the Beck Depression Inventory. Tolerability was determined using a symptom side effects scale. In addition, a variety of laboratory and cardiovascular monitoring was performed. RESULTS No significant differences in treatment outcome between DMI- and placebo-treated groups were determined. Neither DMI, nor its metabolite 2-hydroxy-DMI, nor their ratio, was positively correlated to treatment outcome. The DMI group endorsed more side effects but there were no significant between-group differences in any laboratory, electrocardiographic, or other cardiovascular parameters apart from heart rate, which was increased in the DMI-treated group (p = .03). CONCLUSIONS Given the findings of this study and our review of previously published reports of tricyclic antidepressant treatment in this population, the routine use of short-term (6 weeks) DMI in the treatment of adolescent depression is not supported by the data on hand. Further investigations into what constitutes optimal psychopharmacological treatment of adolescent depression are warranted.
Collapse
Affiliation(s)
- S Kutcher
- Sunnybrook Health Science Centre, North York, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Classification of child (including adolescent) disorders is reviewed within six areas: requirements for a good taxonomy, current systems of classification for children, data-capture methods, reliability and validity, the link between child and adult disorders, and directions for future developments. While substantial progress has been made, there is a continuing need for comparisons of different systems, more systematic yet practicable data capture, proper psychometric analyses of criteria and categories, intensive studies of clinical validity, closer attention to the similarity of, and links between, child and adult categories, and better definition and targeting of those disorders with a serious outcome.
Collapse
|