Psychopharmacologic treatment of pediatric major depressive disorder.
BACKGROUND
The role of pharmacotherapy in the treatment of major depressive disorder (MDD) in youth has received much attention in recent years due to concerns of efficacy and safety of the antidepressants for the treatment of MDD in youth.


OBJECTIVE
This review describes the existing published and unpublished literature regarding the efficacy and short-term safety of the antidepressants and decision-making process required for the use of these medications for youth with MDD. In addition, current continuation and maintenance treatments are discussed.


RESULTS
In general, nine depressed youth must be treated with an antidepressant to obtain one clinical response above that achieved with placebo. To date, fluoxetine has showed the most consistent positive treatment effects. Depressed youth had also acutely responded to other antidepressants, but the response to placebo has also been high. Overall, the antidepressants are well tolerated, but 1-3 children and adolescents of 100 taking antidepressants showed onset or worsening of suicidal ideation and, more rarely, suicide attempts.


CONCLUSIONS
There is a positive risk-benefit ratio for the use of antidepressants in the acute treatment of depressed youth. First-line antidepressant treatment with-or without-specific types of psychotherapy is indicated for youth with MDD of at least moderate severity. All youth taking antidepressants must be closely monitored for suicidality and medication side effects. Many youth will likely require psychotherapy or additional medication treatments to address comorbid disorders. Treatments to prevent relapses and recurrences require further study.
Boylan
Khrista
K
Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1200 Main St. W Box 2000, Hamilton, ON L8N 3Z5, Canada. khrista_boylan@hotmail.com
Romero
Soledad
S
Birmaher
Boris
B
D000293:Adolescent; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology / Q000628:therapy; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D004351:Drug Resistance; D006801:Humans; D018579:Patient Selection; D000297:Psychology, Adolescent; D002666:Psychology, Child; D011613:Psychotherapy / Q000379:methods; D055502:Secondary Prevention; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome
D000928:Antidepressive Agents