Adolescents, major depressive disorder

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). 

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

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. 

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. 

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. 

Major depressive disorder (MDD) is a familial recurrent illness associated with poor psychosocial and academic outcome an increased risk for other psychiatric disorders, suicide, and suicide attempts and a high rate of depression and psychological difficulties in adult life (Birmaher et ah, 1996b Goodyer et ah, 1997 Lewin-sohn et ah, 1999 Pine et ah, 1998 Rao et ah, 1999 Weissman et ah, 1999a,b). The prevalence of MDD in children and adolescents is approximately 2% and 6%, respectively (Birmaher et ah, 1996b). Thus, early identification and prompt treatment of this disorder at its early stages is critical. 

Birmaher, B., Brent, D.A., Kolko, D., Baugher, M., Bridge,/., Holder, D., Iyengar S., and Ulloa, R.E (2000a) Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder. Arch Gen Psychiatry 57 29—36. 

Hughes, C.W, Emslie, G.J., Crismon, M.L., Wagner, K.D., Birmaher, B., Geller, B., Pliszka, S., Ryan, N., Strober, M., Trivedi, M.H., Toprac, M.G., Sedillo, A., Liana, M.E., Lopez, M., Rush, A.J., and Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder (1999). The Texas childhood medication algorithm project report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. / Am Acad Child Adolesc Psychiatry 38 1442-1454. 

Klein, D.N., Lewinsohn, P.M., Seeley, J.R., and Rohde, P. (2001) A family study of major depressive disorder in a community sample of adolescents. Arch Gen Psychiatry 58 13-20. 

Strober, M., Lampert, C., Schmidt, S., and Mottell, W. (1993) The course of major depressive disorder in adolescents I. Recovery and risk of manic switching in a follow-up of psychotic and nonpsychotic subtypes. J Am Acad Child Adolesc Psychiatry 32 34 2. 

High levels of aggression have been reported in adolescents with major depressive disorder (MDD) (Knox et al., 2000). Delinquent youth and youth with CD have high rates of affective illness (Puig-Antich 1987 Pliszka et al., 2000). Children and adolescents suffering from both MDD and antisocial behavior are at highest risk for suicidal acts (Brent et al., 1993). 

Treatment of Major Depressive Disorder in Children and Adolescents... 

Major depressive disorder (MDD) can occur in children as young as 6 years of age. The diagnosis is based on the same criteria as in adults. These patients typically have a high familial loading for psychiatric disorders (110), with more than 70% of mothers having MDD, either pure or complicated by the presence of other psychiatric syndromes. Fathers, however, are more likely to have alcohol abuse or dependence, as opposed to MDD. Given this familial pattern, it is not surprising that many children and adolescents with MDD frequently also meet criteria for other psychiatric syndromes, particularly conduct and oppositional disorder ( 110). 

Hughes C, Preskorn SH, Weller E, et al. Follow-up of adolescents initially treated for prepubertal onset major depressive disorders with imipramine. Psychopharmacol Bull 1990 26 244-248. 

Geller B, Cooper TB, Graham DL, et al. Pharmacokinetically designed double-blind placebo-controlled study of nortriptyline in 6 to 12 year-olds with major depressive disorder. J Am Acad Child Adolesc Psychiatry 1992 31 34-44. 

Emsiie GJ, Rush AJ, Weinberg WA, et al. Recurrence of major depressive disorder in hospitalized children and adolescents. J Am Acad Child Adolesc Psychiatry 1997 36 785-792. 

Hughes CW et al Texas Children s Medication Algorithm Project update from Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry 2007 46(6) 667. 

Mood symptoms of depression are associated with many conditions in addition to major depressive disorder, including mood and anxiety symptoms in schizophrenia, schizoaffective disorder, bipolar manic/depressed/mixed/rapid cycling states, organic mood disorders, psychotic depression, childhood and adolescent mood disorders, treatment-resistant mood disorders, and many more (see Chapter 10, Fig. 10-6). Atypical antipsychotics are enjoying expanded use for the treatment of symptoms of depression and anxiety in schizophrenia that are troublesome but not severe enough to reach the diagnostic threshold for a major depressive episode or anxiety disorder in these cases the antipsychotics are used not only to reduce such symptoms but hopefully also to reduce suicide rates, which are so high in schizophrenia (Fig. 11 — 53). Atypical antipsychotics may also be useful adjunctive treatments to anti-... 

The Spitzer suit claimed, GSK has engaged in repeated and persistent fraud by misrepresenting, concealing and otherwise failing to disclose to physicians information in its control concerning the safety and effectiveness of its antidepressant medication paroxetine... in treating children and adolescents with Major Depressive Disorder. ... 

An urgent meeting of the Group was convened on 4 June 2003 to consider clinical trial data which had just been received by the MHRA on the safety of paroxetine in the treatment of major depressive disorder in children and adolescents. Child and adolescent psychiatrists were invited to join the Group as visiting experts for the discussion of the data. The advice of the group informed CSM s announcement on 10 June, that paroxetine was contraindicated in patients under the age of 18 with major depressive disorder. 

Committee on Safety of Medicines. Selective Serotonin Reuptake Inhibitors (SSRIs) overview of regulatory status and CSM advice relating to major depressive disorder (MDD) in children and adolescents including a summary of available safety and efficacy data. http /medicines.mh-ra.gov.uk/ourwork/monitorsafequalmed/safetymessages/ ssrioverview 101203.htm, updated 8.10.2004. 

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