Selective serotonin reuptake inhibitors for children and adolescents with major depression: current controversies and recommendations.
Recent warnings about potential serious adverse effects with the selective serotonin reuptake inhibitors in children and adolescents with depression raises questions about the risk-benefit ratio of these drugs in this population. Published safety and efficacy trials of SSRIs for the treatment of youth with depression are critically reviewed. These data were augmented by information from regulatory hearings in 2003-2004 and selected open-label reports. Based on this review, recommendations for medication treatment and monitoring of children and adolescents with major depression on SSRIs are provided. Emerging data from several clinical trials show that the SSRIs provide moderate benefits for youth with depression. In addition, SSRI treatment may be associated with increased risk of behavioral activation, self-harm, and suicidal ideation. Appropriate use of the SSRIs in children and adolescents requires careful diagnostic assessment, evaluation of comorbidity, and close monitoring, especially early in treatment.
Hamrin
Vanya
V
Yale University School of Nursing and West Haven Mental Health Center, New Haven, CT 06536-0740, USA.
Scahill
Lawrence
L
D000293:Adolescent; D000296:Adolescent Psychiatry / Q000379:methods / Q000592:standards; D000367:Age Factors; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D002648:Child; D002665:Child Psychiatry / Q000379:methods / Q000592:standards; D002986:Clinical Trials as Topic; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects / Q000378:metabolism; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology; D004347:Drug Interactions; D004348:Drug Labeling / Q000592:standards; D016903:Drug Monitoring; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012449:Safety; D016728:Self-Injurious Behavior / Q000139:chemically induced; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration
D018687:Antidepressive Agents, Second-Generation; D003577:Cytochrome P-450 Enzyme System; D017367:Selective Serotonin Reuptake Inhibitors