Controversy revisited: Selective serotonin reuptake inhibitors in paediatric depression.
BACKGROUND
Selective serotonin reuptake inhibitors (SSRIs) are currently controversial treatments for paediatric depression. There have been several publications on the subject during recent years. This article summarizes their findings and provides some original thoughts, suggestions, and perspectives.


METHODS
Important and relevant articles presenting original data and published in leading journals during 2003-2005 were identified through a PubMed search. Articles instructive in content were selected. A narrative sequence is used to review the field, build arguments, and propound views.


RESULTS
Ten principal and several other auxiliary studies were identified for scrutiny. The findings of these studies suggest that published clinical trials of SSRIs in paediatric depression have overstated the antidepressant benefits and understated the risks of suicidal ideation and behaviour arising with treatment; the unpublished clinical trial data are even more unfavourable. Nevertheless, the clinical, epidemiological, and forensic data do suggest overall safety and efficacy of the SSRIs, amongst which fluoxetine may have the best risk-benefit profile.


CONCLUSIONS
Psychotherapeutic interventions may not always be feasible or effective, especially when depression is more severe. The failure to prescribe a drug may, at the very least, lead to the loss of the placebo effect. It is therefore suggested that, if the diagnosis of unipolar depression is confident, appropriate doses of fluoxetine may be prescribed to depressed children and adolescents; the use of rescue medication to treat emergent agitation is important, and augmentation with psychotherapy may further improve outcomes. The monitoring of indices of growth may also be necessary.
Andrade
Chittaranjan
C
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India. andrade@nimhans.kar.nic.in
Bhakta
Savita G
SG
Singh
Nagendra M
NM
D000293:Adolescent; D002648:Child; D002652:Child Behavior / Q000187:drug effects / Q000523:psychology; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000188:drug therapy*; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013405:Suicide / Q000523:psychology
D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors