The place of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depressive disorders in children and adolescents. Recommendations of the Main Board of the Polish Psychiatric Association. Part 1 - Clinical efficacy and areas of application

In the adult population of patients with major depression, both psychotherapeutic and pharmacological interventions are effective, but antidepressants remain the mainstay of treatment. In the case of child and adolescent psychiatry, there is still controversy over whether to use pharmacological interventions and which drug to prefer. Although psychotherapeutic treatment is still considered a first-line treatment, antidepressants are widely used to treat depression in children and adolescents, and the number of medications prescribed for this indication has increased over time. In Poland, about 57,000 patients under 18 years of age currently use reimbursed antidepressants. Antidepressants are generally effective and well tolerated by children, but between 31% and 48% will not respond to them and up to 25% will experience side effects. The aim of the study was to present the effectiveness and tolerance of antidepressants used in depression in the pediatric population. Among all SSRIs, the largest amount of data from short-term RCTs and their meta-analyses indicate the effectiveness of fluoxetine in patients diagnosed with depression < 18 years of age. which still makes it the drug of first choice in this indication. However, the results of meta-analyses do not allow to draw clear conclusions as to the effectiveness of individual SSRIs in the treatment of depression in children and adolescents. Single placebo-controlled studies show the efficacy of sertraline, escitalopram and citalopram in the treatment of depression in patients <18 years of age, making them important treatment options worth considering. There is no reliable evidence on the effectiveness of fluvoxamine.

The place of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depressive disorders in children and adolescents. Recommendations of the Main Board of the Polish Psychiatric Association. Part 2 - pharmacological properties and safety of use

The aim of the study was to review studies evaluating the pharmacodynamic properties of selective serotonin reuptake inhibitors (SSRIs) and their safety. SSRIs in patients <18 years of age sometimes have different pharmacokinetic parameters compared to adults, which has a significant impact on their effectiveness and tolerance. The concentration of fluoxetine, fluvoxamine or paroxetine is about 2 times higher in children compared to adolescents and adults, which should be taken into account at the stage of both drug introduction and setting target doses. In the event of significant problems with the selection of the drug and / or dose of the drug due to unsatisfactory efficacy and / or tolerance in a patient < 18 years of age, examination of the dominant polymorphism for the metabolism of a given isoenzyme may be very important. SSRIs are generally well tolerated in patients less than 18 years of age and the majority of adverse reactions (TEAEs) during treatment are mild or moderate. Most RCTs evaluating the efficacy of SSRIs in depression in patients <18 years of age rates of suicidal ideation or suicidal ideation during follow-up are comparable to placebo, suicide attempts are rare, and isolated cases occur in both the active treatment groups and the placebo arm. There was no statistically significant increased risk for antidepressants (including all SSRIs) or psychotherapy or combinations of antidepressants with psychotherapy (except venlafaxine). Only venlafaxine therapy was associated with an increased risk of suicidal behavior and/or ideation in short-term therapy compared to placebo.