Pharmacotherapy of major depressive disorder in adolescents.
BACKGROUND
At any one time, major depressive disorder (MDD) affects 4 - 6% of adolescents. When untreated, MDD leads to a high immediate and subsequent suicide risk, long-term chronicity and a poor psychosocial outcome. Whereas psychotherapy can be effective in mild depression, it seems to be less effective in moderate and severe depression. However, although the use of antidepressants increased markedly during the 1990s, in recent years it has decreased as a result of concerns regarding the emergence of suicidality during antidepressant treatment.


METHODS
Are antidepressants truly effective? What is the relationship between different treatments for depression - psychotherapy and pharmacotherapy - alone or in combination? Can antidepressants increase the risk of suicide in some adolescents? Can antidepressants reduce suicide risk in suicidal adolescents?


RESULTS
There is evidence that selective serotonin reuptake inhibitors (SSRIs) can improve adolescent depression better than placebo, although the magnitude of the antidepressant effect is 'small to moderate', because of a high placebo response. The SSRI with the best rate of response compared to placebo is fluoxetine. The increased risk of suicidality in adolescents, compared to adults, is weak but consistent across most studies. However, epidemiological studies do not support a relationship between use of antidepressants and suicide rate.


CONCLUSIONS
A cautious and well-monitored use of antidepressant medications is a first-line treatment option in adolescents with moderate to severe depression. Low rates of remission with current treatment strategies indicate that further research in both psychotherapy and pharmacotherapy is warranted.
Masi
Gabriele
G
Scientific Institute of Child Neurology and Psychiatry, IRCCS Stella Maris, Via dei Giacinti 2, 56018 Calambrone, Pisa, Italy. gabriele.masi@inpe.unipi.it
Liboni
Francesca
F
Brovedani
Paola
P
D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005473:Fluoxetine / Q000008:administration & dosage; D006801:Humans; D018579:Patient Selection; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome
D000928:Antidepressive Agents; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors