1
|
Strawn JR, Mills JA, Poweleit EA, Ramsey LB, Croarkin PE. Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents. Pharmacotherapy 2023. [PMID: 36651686 PMCID: PMC10378577 DOI: 10.1002/phar.2767] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) and, to a lesser extent, serotonin-norepinephrine reuptake inhibitors (SNRIs) are the cornerstone of pharmacotherapy for children and adolescents with anxiety and depressive disorders. These medications alleviate symptoms and restore function for many youths; however, they are associated with a distinct adverse effect profile, and their tolerability may complicate treatment or lead to discontinuation. Yet, SSRI/SNRI tolerability has received limited attention in the pediatric literature. METHODS This review examines the early- (e.g., activation, gastrointestinal symptoms, sedation) and late-emerging (e.g., weight gain) adverse effects of SSRIs and some SNRIs in pediatric patients. RESULTS We provide a framework for discussing SSRI/SNRI tolerability with patients and their families and describe the pharmacologic basis, course, and predictors of adverse events in youth. Strategies to address specific tolerability concerns are presented. For selected adverse events, using posterior simulation of mean differences over time, we describe their course based on Physical Symptom Checklist measures in a prospective, randomized trial of anxious youth aged 7-17 years who were treated with sertraline (n = 139) or placebo (n = 76) for 12 weeks in the Child/Adolescent Anxiety Multimodal Study (CAMS). MAIN RESULTS In CAMS, the relative severity/burden of total physical symptoms (p < 0.001), insomnia (p = 0.001), restlessness (p < 0.001), nausea (p = 0.002), abdominal pain (p < 0.001), and dry mouth (p = 0.024) decreased from baseline over 12 weeks of sertraline treatment, raising the possibility that these symptoms are transient. No significant changes were observed for sweating (p = 0.103), constipation (p = 0.241), or diarrhea (p = 0.489). Finally, we review the antidepressant withdrawal syndrome in children and adolescents and provide guidance for SSRI discontinuation, using pediatric pharmacokinetic models of escitalopram and sertraline-two of the most used SSRIs in youth. CONCLUSION SSRI/SNRIs are associated with both early-emerging (often transient) and late-emerging adverse effects in youth. Pharmacokinetically-informed appraoches may address some adverse effects and inform SSRI/SNRI discontinuation strategies.
Collapse
Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Child and Adolescent Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey A Mills
- Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ethan A Poweleit
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura B Ramsey
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
2
|
Bungener SL, Post L, Berends I, Steensma TD, de Vries ALC, Popma A. Talking About Sexuality With Youth: A Taboo in Psychiatry? J Sex Med 2022; 19:421-429. [PMID: 35105513 DOI: 10.1016/j.jsxm.2022.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Young people who have psychiatric problems are more likely than their peers to endure difficulties during their sexual and gender identity development. AIM This study aims to examine the communication between mental health care providers and their patients about the topics of relations, sexuality and gender identity, including a description of professionals' attitudes toward these topics and the factors that contribute to and inhibit communication. METHODS Study participants (n = 242, response rate = 31%) were a representative sample of a large multicenter cohort of 768 mental health care professionals (eg, medical doctors, psychiatrists, psychologists, group counselors, parent counselors) of 7 institutions and 5 solo practices in the Netherlands, who completed a survey on communication about sexuality and gender identity with their young patients (age 12-21 years). OUTCOMES Sexuality and gender identity are infrequently discussed by mental health care providers with their young patients or their patients' parents. RESULTS Of the study sample, 99.5 % valued sexuality as an important topic to discuss with their patients. However, only 17.1% of the professionals reported that they discussed sexuality-related issues with the majority (>75%) of their patients (adolescents: 19.9%, parents: 14.4%) Additionally, only 2.3 % of the participants discussed gender nonconformity regularly with patients. Information about sexual side effects of prescribed medication was infrequently (20.3%) provided: antidepressants (40.0%), antipsychotics (34.0%), benzodiazepines (5.1%) and stimulants (2.4%). The most frequently cited reasons for not discussing these topics were a lack of awareness, own feelings of discomfort, and the patients' supposed feelings of shame. There was no gender differences observed. CLINICAL IMPLICATIONS Recommendations for professionals include to be aware of these topics, initiating age-appropriate conversation and use inclusive language. STRENGTHS AND LIMITATIONS The present study included a diverse and representative group of mental health care professionals. Frequency of sexual communication was based on self-report, which brings a risk of bias. CONCLUSION Despite a recognized need to engage in age-appropriate communication about sexuality and gender identity in youth mental health care, mental health providers seem to remain hesitant to discuss such topics. Bungener SL, Post L, Berends I, et al. Talking About Sexuality With Youth: A Taboo in Psychiatry?. J Sex Med 2022;19:421-429.
Collapse
Affiliation(s)
- Sara L Bungener
- Center of Expertise on Gender Dysphoria, Department of Child and Adolescent Psychiatry, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Laura Post
- Center of Expertise on Gender Dysphoria, Department of Child and Adolescent Psychiatry, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Inez Berends
- Center of Expertise on Gender Dysphoria, Department of Child and Adolescent Psychiatry, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Thomas D Steensma
- Center of Expertise on Gender Dysphoria, Department of Child and Adolescent Psychiatry, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Annelou L C de Vries
- Center of Expertise on Gender Dysphoria, Department of Child and Adolescent Psychiatry, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Arne Popma
- Center of Expertise on Gender Dysphoria, Department of Child and Adolescent Psychiatry, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Specialty knowledge and competency standards for pharmacotherapy for pediatric obsessive-compulsive disorder. Psychiatry Res 2021; 299:113858. [PMID: 33770712 DOI: 10.1016/j.psychres.2021.113858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/06/2021] [Indexed: 12/28/2022]
Abstract
Evidence based treatments for pediatric Obsessive-Compulsive Disorder (OCD) are delivered with varying levels of expertise. This paper is part of the phase two series by the International OCD Accreditation Task Force (ATF) to advance a standardized high level of care globally. This paper presents specific knowledge and competencies recommended for specialized practice for pediatric psychopharmacologists working with OCD, developed by an international group of clinicians with extensive expertise in assessment and treatment of OCD. Tabulated knowledge and competency standards are operationalized as clinician abilities with specification of evidence for each standard. The distinction between current practice guidelines and ATF standards is discussed. Drug treatment has a solid evidence base. However, it should not be applied isolated, but informed by broad competence in general child and adolescent psychiatry and pediatrics. Other treatment relevant areas such as specialty CBT, family functioning, developmental issues, and neurobiology require consideration. Drug treatment includes several phases with varying degrees of evidence: Starting up medication, titration to maximum tolerated dose, maintenance, termination, and relapse prevention. In complex cases, pharmacotherapy with weak evidence may be needed to target symptoms and/or co-morbidity. The ATF knowledge and competency standards presented will be reviewed and updated commensurate with research.
Collapse
|
4
|
Deumic E, Butcher BD, Clayton AD, Dindo LN, Burns TL, Calarge CA. Sexual Functioning in Adolescents With Major Depressive Disorder. J Clin Psychiatry 2016; 77:957-62. [PMID: 27464316 PMCID: PMC5520806 DOI: 10.4088/jcp.15m09840] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/09/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine sexual functioning in adolescents with depression. METHODS Between September 2010 and March 2014, 235 participants who were between 15 and 20 years old and were unmedicated or within 1 month of beginning antidepressant treatment completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Changes in Sexual Functioning Questionnaire (CSFQ). They were also assessed to establish the presence of a DSM-IV-TR major depressive episode (MDE). The Student t test and χ² test were used to compare continuous and categorical variables, respectively, across participants with versus without MDE. Multivariable linear regression analysis examined the association between depression and sexual functioning. RESULTS After the investigators controlled for age, female sex, antidepressant use, and the presence of generalized anxiety disorder, the presence of MDE was associated with a lower score on the CSFQ overall (P < .0007) and on its desire (P < .09), arousal (P < .001), and orgasm (P < .007) subscales. Antidepressants were not associated with sexual functioning either in the sample overall or in those with MDE. Beck Depression Inventory items related to affective symptoms (P < .03), rather than those tapping into neurovegetative or cognitive functioning, accounted for the association between depression and lower sexual functioning. Furthermore, with higher BDI scores, males exhibited a steeper decline than females in both the CSFQ total score and the desire subscale (sex × BDI score interaction effect: P < .03). Anxiety was not significantly associated with sexual functioning. CONCLUSIONS Major depressive disorder in older adolescents is associated with lower sexual functioning, particularly in males. This appears most related to affective symptoms. The potential impact of such impairment on future sexual functioning deserves further examination. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02147184.
Collapse
Affiliation(s)
- Emira Deumic
- Carver College of Medicine, bDepartment of Psychiatry, and cCollege of Public Health, University of Iowa, Iowa City
| | | | - Anita D Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville
| | - Lilian N Dindo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Chadi A Calarge
- Baylor College of Medicine, 1102 Bates Ave, Suite 790, Houston, TX 77030.
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston
| |
Collapse
|
5
|
Mosheva M, Mekori E, Kantor S, Berg Y, Weizman A, Gothelf D. Do Antidepressants Induce Psychosis in Children and Adolescents? A Naturalistic Study in Ambulatory Pediatric Population. J Child Adolesc Psychopharmacol 2016; 26:478-84. [PMID: 27166781 DOI: 10.1089/cap.2015.0229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the present study was to examine if selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) induce psychotic symptoms in children and adolescent outpatients. We secondarily aimed to assess the occurrence of adverse events (AE), with particular interest in psychiatric adverse events (PAE), timing of their onset, and the effectiveness of antidepressants in children and adolescents. METHODS We retrospectively evaluated the computerized medical records of children and adolescents treated with antidepressants (SSRIs or SNRIs) for depressive disorders, anxiety disorders, and obsessive-compulsive disorders. AE and Clinical Global Impressions scores were recorded. RESULTS Sixty-nine children and adolescents aged 13.3 ± 3.0 years were included. None of the patients treated presented with acute psychotic symptoms (delusions, hallucinations, and disorganized thinking or behavior). Duration of treatment extended over 13.4 ± 11.8 months. PAE occurred in 39% of cases. Of these, 16% included suicidality (ideations or attempts), and 3% included nonpsychotic hypomanic symptoms. Significant clinical improvement was achieved in 41% of patients. CONCLUSIONS In contrast to the clinical impression of some clinicians, antidepressant treatment in pediatric ambulatory population was not associated with emergence of psychotic symptoms.
Collapse
Affiliation(s)
- Mariela Mosheva
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Ehud Mekori
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Shir Kantor
- 3 University of Maryland, College Park , Maryland
| | - Yael Berg
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Abraham Weizman
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,4 Research Unit, Geha Mental Health Center , Petah Tikva, Israel
| | - Doron Gothelf
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| |
Collapse
|
6
|
Affiliation(s)
- Amir Levine
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York, New York
| | | |
Collapse
|
7
|
Camporeale A, Day KA, Ruff D, Arsenault J, Williams D, Kelsey DK. Profile of sexual and genitourinary treatment-emergent adverse events associated with atomoxetine treatment: a pooled analysis. Drug Saf 2014; 36:663-71. [PMID: 23775507 DOI: 10.1007/s40264-013-0074-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder that begins in childhood. Atomoxetine is a selective inhibitor of the presynaptic norepinephrine transporter. Several studies have demonstrated the safety and efficacy of atomoxetine in the treatment of ADHD. OBJECTIVE The objective of this analysis was to provide additional information on the frequency, time to onset and time to resolution of sexual and genitourinary (GU) treatment-emergent adverse events (TEAEs) reported during atomoxetine treatment in clinical trials. METHODS Data from all adult atomoxetine placebo-controlled ADHD trials were pooled for this analysis, for a total of 3,314 patients (atomoxetine, n = 1,738; placebo, n = 1,576). Additionally, data from all adolescent patients (baseline age ≥13 to <18 years) within all ADHD placebo-controlled trials were pooled for analysis, for a total of 538 patients (atomoxetine, n = 329; placebo, n = 209). Rates of sexual and GU TEAEs were summarized by sex for each age group. Time to onset and resolution of sexual and GU TEAEs were summarized and compared using Kaplan-Meier methods. RESULTS Overall, the baseline characteristics of randomized patients in the atomoxetine and placebo groups were similar. Profiles of sexual and GU TEAEs for atomoxetine appeared clinically similar to placebo in female patients and in adolescent male patients. Adult male patients reported relatively more sexual and GU TEAEs when taking atomoxetine compared with placebo, with libido decreased (4.6 vs. 3.0 %), dysuria (3.7 vs. 1.5 %), urinary hesitation (6.9 vs. 2.4 %), urine flow decreased (2.5 vs. 0.6 %), ejaculation disorder (2.8 vs. 1.1 %) and erectile dysfunction (8.0 vs. 1.9 %) being the most common. The time to onset of the most common TEAEs in adult male patients tended to occur relatively early in dosing: within the first 2 weeks for GU TEAEs, and during the second and third week of dosing for erectile and ejaculation issues. The median time to resolution for these events ranged from around 3-8 weeks after event onset, depending on the event. While the common sexual and GU TEAEs showed numerically higher percentages of discontinuations in atomoxetine-treated patients compared with placebo, most incidences of the sexual and GU TEAEs were not considered severe. CONCLUSIONS The sexual and GU TEAE profiles of patients taking atomoxetine were generally similar to those of patients taking placebo in the female and adolescent male populations, with greater frequency of TEAEs reported in adult males taking atomoxetine compared with placebo. The time to onset of the TEAEs tended to be shorter, and time to resolution tended to be longer in adult male patients treated with atomoxetine compared with those receiving placebo. The conclusions must be interpreted with caution because the TEAEs were likely underreported.
Collapse
Affiliation(s)
- Angelo Camporeale
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285, USA
| | | | | | | | | | | |
Collapse
|
8
|
Affiliation(s)
- M. Sasikumar
- a Department of Chemistry , University of Pune , Ganeshkhind , Pune , Maharashtra, India
| | - Milind D. Nikalje
- a Department of Chemistry , University of Pune , Ganeshkhind , Pune , Maharashtra, India
| |
Collapse
|
9
|
Sexual Side Effects of Antidepressant Medications: An Informed Consent Accountability Gap. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2008. [DOI: 10.1007/s10879-008-9094-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
10
|
Abstract
Antidepressants are efficacious for pediatric major depressive disorder, obsessive compulsive disorder (OCD), and non-OCD anxiety disorders. Antidepressants should be used in an evidence-based fashion, with frequent monitoring for side effects, especially when initiating treatment and adjusting dosage. With diligence to appropriate prescribing and monitoring, the benefits of therapy outweigh the potential of treatment related risk.
Collapse
Affiliation(s)
- Tanya K Murphy
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA.
| | | | | | | |
Collapse
|
11
|
Reinblatt SP, Riddle MA. The pharmacological management of childhood anxiety disorders: a review. Psychopharmacology (Berl) 2007; 191:67-86. [PMID: 17205317 DOI: 10.1007/s00213-006-0644-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2006] [Accepted: 11/05/2006] [Indexed: 01/08/2023]
Abstract
RATIONALE Pediatric anxiety is a prevalent psychiatric disorder that may have important implications for school, social, and academic function. Psychopharmacological approaches to the treatment of pediatric anxiety have expanded over the past 20 years and increasing empirical evidence helps guide current clinical practice. OBJECTIVE To review studies which examine the pharmacological treatment of pediatric anxiety disorders, including obsessive-compulsive disorder and to summarize treatment implications. METHODS All relevant studies were searched using MEDLINE and PsycINFO search engines, supplemented by a manual bibliographical search; studies published between 1985 and 2006 that met inclusion criteria were examined. RESULTS This article provides a systematic review of the psychopharmacological treatment of pediatric anxiety disorders based on available empirical evidence, with a focus on randomized controlled trials. General treatment principles and pharmacological management of specific pediatric anxiety disorders are also reviewed. CONCLUSION There is good evidence to support the efficacy of several pharmacological agents including the selective serotonin reuptake inhibitors to treat pediatric anxiety and obsessive-compulsive disorder, although there are still many unanswered questions.
Collapse
Affiliation(s)
- Shauna P Reinblatt
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., CMSC 312, Baltimore, MD, USA.
| | | |
Collapse
|
12
|
Rappaport N, Bostic JQ, Prince JB, Jellinek M. Treating pediatric depression in primary care: coping with the patients' blue mood and the FDA's black box. J Pediatr 2006; 148:567-8. [PMID: 16737859 DOI: 10.1016/j.jpeds.2006.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
13
|
Azam U. Late-stage clinical development in lower urogenital targets: sexual dysfunction. Br J Pharmacol 2006; 147 Suppl 2:S153-9. [PMID: 16465180 PMCID: PMC1751495 DOI: 10.1038/sj.bjp.0706638] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In recent years, late-stage clinical drug development that primarily focuses on urogenital targets has centered around four areas of medical need (both unmet need and aiming to improve on existing therapies). These include male sexual dysfunction (MSD), female sexual dysfunction (FSD), prostatic pathology (neoplastic, pre-neoplastic, and non-neoplastic), and improvement in lower urinary tract symptoms. Despite the regulatory approval of compounds to treat erectile dysfunction (ED), benign prostatic hyperplasia, a number of treatments for overactive bladder, and stress urinary incontinence, there remains a deficiency in addressing a number of conditions that arise out of pathophysiological dysfunction resulting in lower urogenital tract sexual conditions. In terms of late-stage clinical development, significant progress has most recently been made in MSD development, especially in understanding further a common and complex sexual dysfunction--that of premature ejaculation. The search also continues for compounds that improve ED in terms of better efficacy and superior safety profile compared to the currently marketed phosphodiesterase-5-inhibitors. Whilst there are no approved medications to treat the subtypes of FSD, there has been significant progress in attempting to better understand how to appropriately assess treatment benefit in clinical trial settings for this difficult to diagnose and treat condition. This review will focus on late-stage human clinical development pertaining to MSD and FSD.
Collapse
Affiliation(s)
- Usman Azam
- Johnson & Johnson Pharmaceutical Research & Development, Raritan, NJ 08869, USA.
| |
Collapse
|
14
|
Jackson B, Lurie S. Adolescent depression: challenges and opportunities: a review and current recommendations for clinical practice. Adv Pediatr 2006; 53:111-63. [PMID: 17089865 DOI: 10.1016/j.yapd.2006.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many aspects of the treatment for adolescent depression are still uncertain. However, our body of knowledge continues to accumulate, and our approaches continue to be refined. When we remember that 40 years ago the field was still arguing about the existence of depression in youth, it is clear that significant progress has been made. Recent controversies have provided another opportunity to step back and re-evaluate. Given the chronicity, morbidity, and mortality associated with adolescent depression, the risks of doing nothing are too great. Evidence-based research has provided us with some direction during this unsettling time. After careful reviews, the major professional organizations representing pediatric medicine and psychiatry all support the continued use of SSRI antidepressant medications but emphasize close monitoring. The debates also have heightened interest in effective psychotherapy approaches, particularly CBT and IPT. Given the risk for suicidality in depressed adolescents, assessment and management of safety concerns remain critical, regardless of medication usage. Above all, it is most important that we remain hopeful about our ability to guide adolescents and families through the struggles with depression toward recovery.
Collapse
Affiliation(s)
- Brad Jackson
- Department of Psychiatry and Behavioral Sciences, The Children's Hospital, Box 361, 1056 East 19th Avenue, Denver, CO 80218, USA.
| | | |
Collapse
|
15
|
Abstract
This article reviews the psychopharmacologic treatment of child and adolescent anxiety disorders and is divided into the following sections: historical background, general treatment principles, obsessive-compulsive disorder, other anxiety disorders, including separation anxiety disorders, generalized anxiety disorder, and social phobia, elective mutism, and post-traumatic stress disorder and specific phobia. Short-term and long-term psychopharmacologic treatment strategies are reviewed, as are approaches for managing comorbidity and treatment-refractory cases. This article is organized by diagnostic categories rather than by medication classes to emphasize the clinical perspective.
Collapse
Affiliation(s)
- Shauna P Reinblatt
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | | |
Collapse
|