The use of selective serotonin reuptake inhibitors in children and adolescents with major depression.
OBJECTIVE
Recent warnings about suicidal thoughts and self-injurious behavior in youth treated with selective serotonin reuptake inhibitors raise fundamental questions about the risk-benefit ratio of this class of medications.


METHODS
Data from placebo-controlled trials are used to elucidate the potential risks and benefits of the selective serotonin reuptake inhibitors (SSRIs) in children and adolescent with major depression. This analysis forms the basis of clinical recommendations.


METHODS
The review includes the six large-scale, placebo-controlled trials that have been published over the past decade. These data were augmented by information from regulatory hearings in 2003-2004 and selected open-label reports.


CONCLUSIONS
Emerging data from several clinical trials show that the SSRIs have modest effects on childhood depression. In addition, SSRI treatment may be associated with behavioral activation, self-harm, and suicidal ideation. Appropriate use of SSRIs in children and adolescents requires careful diagnostic assessment, evaluation of co-occurring conditions, and diligent monitoring, especially within the first weeks of treatment.
Scahill
Lawrence
L
Yale University School of Nursing and Child Study Center, USA. lawrence.scahill@yale.edu
Hamrin
Vanya
V
Pachler
Mary Ellen
ME
D000293:Adolescent; D002648:Child; D015283:Citalopram / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy*; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D017374:Paroxetine / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use; D016896:Treatment Outcome
D015283:Citalopram; D005473:Fluoxetine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline