Pharmacologic treatment of psychiatric and neurodevelopmental disorders in children and adolescents (Part 3)

A meta-analysis of antidepressant outcome studies that involved children and adolescents

A meta-analysis was performed of available studies that document response to antidepressant medications in the pediatric population, based upon guidelines developed in a methodological review of adult antidepressant response (Greenberg, Borstein, Greenberg, & Fisher, 1992). The 27 studies accessed through standard medical and psychological data bases were assessed against the following criteria: degree of blindness, placebo group design, rating issues, sample size, inclusion criteria, and other methodological issues. Serious methodological flaws emerged in all areas, as well as an inverse relationship between positive findings and the presence of adequate experimental controls. Recommendations are made for improvements in experimental methodology, and caution is urged in the absence of well-controlled studies.

Steady-state serum concentrations of imipramine, its main metabolites and clinical response in primary enuresis

Thirty-seven children (6-13 years old), receiving a flexible dosage of imipramine (IMI) for nocturnal enuresis, were evaluated. After a mean time of 8.5 +/- 7.0 weeks of therapy, 40.5% no longer wet the bed; 32.4% had a mean benefit of 80%; 27.01% had a negligible response. The best relationship observed was between clinical effect and drug serum concentrations rather than with drug daily dose, the most satisfactory being that with IMI seric values (P = 0.019). Responders (effect higher than 50%) had higher IMI serum concentrations (P less than 0.05) than poor responders. At 3 and 6 months after stopping the drug, over 90% of the responders maintained the maximum response reached during treatment. The side-effects observed were irritability, reduction of appetite, headache, a mild increase of blood pressure.