Adolescents, major depressive

E. B., Winters, N.C., Oakes, R. and McCafferty, J.P. (2001) Efficacy of paroxetine in the treatment of adolescent major depression a randomized, controlled trial. / Am Acad Child Adolesc Psychiatry 40 762-772. 

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

Efficacy of paroxetine in the treatment of adolescent major depression a randomized, controlled trial. / Am Acad Child Adolesc Psychiatry 40 762-772. 

McConville B, Minnery KL, Sorter MT, et al. An open study of the effects of sertraline on adolescent major depression. J Child Adolesc Psychopharmacol 1996 6 41-51. 

Even worse, GSK made sure that Study 329 was eventually published in a whitewashed form in the prestigious Journal of the American Academy of Child and Adolescent Psychiatry (Keller et ah, 2001). The title left no doubt about the scientific nature of the study Efficacy of Paroxetine in the Treatment of Adolescent Major Depression A Randomized, Controlled Trial. The conclusion to the lengthy analysis, a mere one sentence long, left no doubt about what the reader was supposed to learn Paroxetine is generally well tolerated and effective for major depression in adolescents. That one sentence, so prominently displayed as the last line of the abstract, was a drug company public relations triumph, one bound to vastly increase the off-label prescription to children of their ineffective, dangerous drug. 

Nunes EY, Weissman MM, Goldstein RB, McAvay G, Seracini AM, Verdeli H and Wickra-maratne PJ (1998). Psychopathology in children of parents with opiate dependence and/ or major depression. Journal of the American Academy of Child and Adolescent Psychiatry, 37(11), 1142-1151. 

Two or more major depressive episodes Manic episode major depressive or mixed episode Major depressive episode + hypomanic episode Chronic subsyndromal depressive episodes Chronic fluctuations between subsyndromal depressive and hypomanic episodes (2 years for adults and 1 year for children and adolescents) Mood states do not meet criteria for any specific bipolar disorder... 

Approximately 10% to 15% of adolescents with recurrent major depressive episodes subsequently have an episode of mania or hypomania. 

Suicidaiity in chiidren and adoiescents Antidepressants increased the risk of suicidal thinking and behavior (suicidaiity) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone... 

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). 

Based on existing findings, there are many important hypotheses in pediatric psychopharmacogenetics. Selective serotonin transporter inhibitors have been shown to have efficacy in double-blind studies in children and/ or adolescents in the treatment of autism, major depression, OCD, and anxiety disorders. Given the association of the serotonin transporter promoter variant with SSRI treatment response in adult depression (Smeraldi et ah, 1998), all of the SSRI-responsive phenotypes should be tested for promoter variant influence on response using family-based or population-based controlled association studies. The report of strong 5-HTTLPR allelic effects on SSRI-induced mania (Mundo et ah, 2000) is of special interest given frequent SSRI-induced activation in children. 

Limitations in the Application of Preclinical Models of Effects of Stress in Organizing Neurobiological Correlates of Major Depressive Disorder in Children and Adolescents... 

TABLE 10.1. Neuroimaging Studies of Children and Adolescents with Major Depression... 

Lewinsohn, P.M., Clarke, G.N., Seeley, J.R., and Rohde, P. (1994) Major depression in community adolescents age at onset, episode duration, and time to recurrence [see comments]. J Am Acad Child Adolesc Psychiatry 33 809-818. 

Tutus, A., Kibar, M., Sofuoglu, S., Basturk, M., and Gonul, A.S. (1998) A technetium-99m hexamethylpropylene amine oxime brain single-photon emission tomography study in adolescent patients with major depressive disorder. Eur J Nucl Med 25 601— 606. 

Kessler, R.C. and Walters, E.E. (1998) Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey. Depress Anxiety 7 3-14. 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

Emslie, G.J., Armitage, R., Weinberg, W.A., Rush, A.J., Mayes, T.L., and Hoffmann, R.E (2001) Sleep polysomnography as a predictor of recurrence in children and adolescents with major depressive disorder. Int J Neuropsychopharmacol 4 159-168. 

Geller, B., Cooper, T.B., Graham, D.L., Fetner, H.H., Marsteller, F.A., and Wells, J.M. (1992) Pharmacokinetically designed doubleblind placebo-controlled study of nottriptyline in 6- to 12-yeat-olds with major depressive disorder. / Am Acad Child Adolesc Psychiatry 31 34—44. 

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). 

Mandoki, M.W., Tapia, M.R., Tapia, M.A., Sumner, G.S., and Parker, J.L. (1997) Venlafaxine in the treatment of children and adolescents with major depression. Psychopharmacol Bull 33 149-154. 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

Bitmaher, B., Dahl, R.E., Williamson, D.E., Perel, J.M., Btant. D.A., Axelson, D.A., Kaufman. J., Don, L.D., and Still, S. (2000) Growth hormone secretion in children and adolescents at high risk for major depressive disorder. Arch Gen Psychiatry 57 867-872. 

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