Adolescents antidepressants

Suicidality in children and adolescents Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of trazodone or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Trazodone not approved for use in pediatric patients (see Clinical worsening and suicide risk and Children sections in Warnings). 

Suicidality in children and adolescents Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of olanzapine/fluoxetine or any other antidepressant in a child or adolescent must balance this risk with clinical need. 

Wilens TE, Biederman J, Spencer TJ Case study adverse effects of smoking marijuana while receiving tricyclic antidepressants. J Am Acad Child Adolesc Psychiatry 36 481 85, 1997... 

Antidepressant medications appear to be useful for certain children and adolescents, particularly those who have severe or psychotic depression, fail psychotherapeutic measures, or experience chronic or recurrent depression. SSRIs generally are considered the initial antidepressants of choice, although comorbid conditions may favor alternative agents. Clinicians should be aware of the possibility of behavioral activation with the SSRIs, including such symptoms as impulsivity, silliness, daring conduct, and agitation.44 Desipramine should be used with caution in this population because of several reports of sudden death, and a baseline and follow-up electrocardiogram (ECG) may be warranted when this medication is used to treat pediatric patients.9... 

The FDA has established a link between antidepressant use and suicidality (suicidal thinking and behaviors) in children, adolescents, and young adults 18 to 24 years old. All antidepressants carry a black box warning advising caution in the use of all antidepressants in this population, and the FDA also recommends specific monitoring parameters. The clinician... 

Data supporting efficacy of antidepressants in children and adolescents are sparse. Fluoxetine is the only antidepressant that is FDA approved for treatment of depression in patients less than 18 years of age. 

Unfortunately, the mood stabilizers have not proved very helpful in the treatment of uncomplicated ADHD. They can, however, help the child or adolescent who has ADHD complicated by severely disruptive behavior. For example, a child with ADHD or ODD who is prone to outbursts of rage that are not controlled by other medications such as antidepressants or clonidine may require a mood stabilizer. 

Antidepressants and clonidine are the most commonly used augmentation strategies for ADHD. If the patient has tics or is troubled by insomnia, clonidine is a reasonable choice. After collecting a baseline EKG, clonidine should be started at 0.05 mg at bedtime for children and adolescents and 0.1 mg at bedtime for adults. The dose can be increased every 2 weeks or so while monitoring the patient s blood pressure and pulse. Although it has not been studied as well, guanfacine may work in much the same manner as clonidine. 

Jureidini JN, Doecke CJ, Mansfield PR, Haby MM, Menkes DB, Tonkin AL. Efficacy and safety of antidepressants for children and adolescents. BMJ 2004 328(7444) 879-83. 

Blederman,]. (1991) Sudden death in children treated with a tricyclic antidepressant. / Am Acad Child Adolesc Psychiatry 30 495 97. 

Daly, J.M. and Wllens, T. (1998) The use of tricyclic antidepressants in children and adolescents. Pediatr Clin North Am. 45 1123-1135. 

Varley, C.K. and McClellan, J. (1997) Case study two additional sudden deaths with tricyclic antidepressants. / Am Acad Child Adolesc Psychiatry 36 390—394. 

This chapter will review available atypical antidepressants and will specifically discuss their uses in children and adolescents. At this time, it is important to note that none of the agents discussed in the chapter have an FDA indication for use in children and adolescents however, the use of these agents in children and adolescents is increasing, and knowledge of these agents is critical for both research and clinical practice. 

Venlafaxine is not FDA approved for use in children below the age of 18 however, it has been used in this population as an antidepressant as well as treatment for ADHD. In 1997, a placebo-controlled trial for children and adolescents (n = 32) diagnosed with major depression failed to show a difference between the control and venlafaxine groups (Mandoki, et al., 1997), possibly because of subtherapeutic doses of venlafaxine. A 5-week open trial of venlafaxine (n = 14) in children and adolescents (ages 8-14) with ADHD yielded significant improvements in parent ratings of hyperactivity and impulsivity on the Conners Parent rating scales (Olvera et ah, 1996). 

Ryan, N.D., Puig-Antich, J., Rabinovich, H., Fried, J., Ambrosini, P., Meyer, V., Torres, D., Dachille, S., and Mazzie, D. (1988). MAOIs in adolescent majot depression unresponsive to tricyclic antidepressants. J Am Acad Child Adolesc Psychiatry 27 755— 758. 

In the treatment of children and adolescents with anxiety disorders clinicians have a wide variety of pharmacologic options beyond the antidepressants (Shader and Greenblatt, 1995 Lydiard et ah, 1996 Riddle et ah, 1999). The benzodiazepines (BZs), with their favorable safety profile and quick onset of action, are attractive alternatives for the treatment of acute anxiety. While the clinical effectiveness of buspirone has not been proven in children, buspirone is used alone or in combination with other drugs in the treatment of anxiety disorders. The antihistamines are often used to treat insomnia and may reduce acute mild agitation. Zolpidem (Ambien) is occasionally used for its sedative properties. This chapter reviews the structure, proposed mechanisms of action, pharmacodynamic principles, and pharmacokinetic principles of these drugs. 

Birmaher, B. (1998) Should we use antidepressant medications for children and adolescents with depressive disorders Psychophar-macol Bull 34 35-39. 

Abramowicz, M., ed. (1990) Sudden Death in Children Treated with a Tricyclic Antidepressant. Med Lett Drugs Ther 32.53. Abramowitz, A.J. (1994) Classroom interventions for disruptive behavior disorders. Child Adolesc Psychiatr Clin North Am 3 343-360. 

Most child and adolescent studies published thus far have focused on the effects of the tricyclic antidepressants (TCAs) and, more recently, the SSRIs. A few open studies have also shown that monoamine oxidase inhibitors (MAOIs) can be used safely with children and adolescents (Ryan et ah, 1988b), but noncompliance with dietary requirements may present a significant problem for minors. Other antidepressants, including the heterocyclics (HTC) (e.g., amoxapine, maprotiline), buproprion, venlafaxine, and nefazodone, have been found to be efficacious for the treatment of depressed adults (APA, 2000), but they have not been well studied for the treatment of MDD in children and adolescents. Therefore, this chapter mainly describes the use of SSRIs and TCAs for youth with MDD. 

In children and adolescents, the half-times for antidepressants such as paroxetine, sertraline, and citalopram are between 14 and 16 hours (Clein and Riddle, 1995 Findling et ah, 1999 (Axelson et ak, 2000 a,b). This suggests that these medications, particular when prescribed at lower doses, need to be administered twice a day. Otherwise, children and adolescents can expe-... 

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