Texas Children's Medication Algorithm Project: update from Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder.
OBJECTIVE
To revise and update consensus guidelines for medication treatment algorithms for childhood major depressive disorder based on new scientific evidence and expert clinical consensus when evidence is lacking.


METHODS
A consensus conference was held January 13-14, 2005, that included academic clinicians and researchers, practicing clinicians, administrators, consumers, and families. The focus was to review, update, and incorporate the most current data to inform and recommend specific pharmacological approaches and clinical guidance for treatment of major depressive disorder in children and adolescents.


RESULTS
Consensually agreed on medication algorithms for major depression (with and without psychosis) and comorbid attention-deficit disorders were updated. These revised algorithms also incorporated approaches to address issues of suicidality, aggression, and irritability. Stages 1, 2, and 3 of the algorithm consist of selective serotonin reuptake inhibitor and norepinephrine serotonin reuptake inhibitor medications whose use is supported by controlled, acute clinical trials and clinical experience. Recent studies provide support that selective serotonin reuptake inhibitors in addition to fluoxetine are still encouraged as first-line interventions. The need for additional assessments, precautions, and monitoring is emphasized, as well as continuation and maintenance treatment.


CONCLUSIONS
Evidence and expert clinical consensus support the use of selected antidepressants in the treatment of depression in youths. The use of the recommended antidepressant medications requires appropriate monitoring of suicidality and potential adverse effects and consideration of other evidence-based treatment alternatives such as cognitive behavioral therapies.
Hughes
Carroll W
CW
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio. Electronic address: carroll.hughes@utsouthwestern.edu.
Emslie
Graham J
GJ
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Crismon
M Lynn
ML
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Posner
Kelly
K
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Birmaher
Boris
B
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Ryan
Neal
N
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Jensen
Peter
P
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Curry
John
J
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Vitiello
Benedetto
B
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Lopez
Molly
M
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Shon
Steve P
SP
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Pliszka
Steven R
SR
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Trivedi
Madhukar H
MH
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
D000293:Adolescent; D000465:Algorithms; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D012449:Safety; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D013781:Texas; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors