title: Tricyclic antidepressants in adolescent depression. A case report.
abstract: A boy aged 11 years 11 months, with normal premorbid personality, presented with a severe depressive episode with somatic and psychotic features. A clinical response to amitriptyline was complicated by ECG changes leading to the abrupt withdrawal of amitriptyline, with the development of a withdrawal syndrome. Further trials of antidepressant medication were unsuccessful, including paroxetine (clinical deterioration), lofepramine (ECG changes and clinical deterioration), and trazodone (priapism). Finally, a good clinical response to dothiepin augmented with lithium was achieved. ECG changes were assessed as being idiosyncratic responses to medication, rather than ischaemic in nature. A dose/response relationship with dothiepin was observed. All medication was successfully stopped after 26 months of treatment. Clinical phenomena relevant to the development of guidelines for use of tricyclic antidepressants in childhood and adolescence are discussed.
authors.affiliation: Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London, United Kingdom.
authors.forename: C L
authors.initials: CL
authors.lastname: Evans
authors.forename: Y
authors.initials: Y
authors.lastname: Ha
authors.forename: S
authors.initials: S
authors.lastname: Saisch
authors.forename: Z
authors.initials: Z
authors.lastname: Ellison
authors.forename: E
authors.initials: E
authors.lastname: Fombonne
mesh_terms: D000639:Amitriptyline / Q000009:adverse effects; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D004308:Dothiepin / Q000627:therapeutic use*; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008127:Lofepramine / Q000009:adverse effects; D008297:Male; D017374:Paroxetine / Q000009:adverse effects; D014196:Trazodone / Q000009:adverse effects
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline; D016651:Lithium Carbonate; D017374:Paroxetine; D008127:Lofepramine; D004308:Dothiepin; D014196:Trazodone