Children depressive disorders

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. 

Kaufman, J. (1991) Depressive disorders in maltreated children. / Am Acad Child Adolesc Psychiatry 30 257-265. 

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. 

Birmaher, B., Brent, D.A., and Benson, R.S. (1998) Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. American Academy of Child and Adolescent Psychiatry. / Am Acad Child Adolesc Psychiatry 37 1234-1238. 

Gammon, G.D. and Brown, T.E. (1993). Fluoxetine and methylphenidate in combination for treatment of attention deficit disorder and comorbid depressive disorder. / Child Adolesc Psychopharmacol 3 1-10. 

Clarke, G.N., Hawkins, W, Murphy, M., Sheerer, L.B., Lewiston, P.M., and Seeley, J.R. (1995) Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents a randomized trial of a group cognitive intervention. / Am Acad Child Adolesc Psychiatry 34 312-321. 

Emslie, G.J., Rush, A.J., Weinberg, W.A., Gullion, C.M., Rintel-mann, J., and Hughes, C.W (1997a) Recurrence of major depressive disorder in hospitalized children and adolescents. / Am Acad Child Adolesc Psychiatry 36 785—792. 

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. 

Puig-Antich, J., Perel, J., Lupatkinm, W., Chambers, W.J., Shea, C., Tabrizi, M.A., and Stiller, R.L. (1979) Plasma levels of imipra-mine (IMI) and desmethylimipramine (DMI) and clinical response in prepubertal major depressive disorder. A preliminary report./ Amer Acad Child Psychiatry 18 616-627. 

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. 

Wood, A., Harrington, R., and Moore, A. (1996) Controlled trial of a brief cognitive-behavioral intervention in adolescent patients with depressive disorders. / Child Psychol Psychiatry 37 737-746. 

The issues of whether depression is underdiagnosed, and more generally, whether the construct of depression is also applicable to children, have been discussed in both Europe (Rutter et ah, 1986) and the United States (Beardslee et ah, 1985). As in the DSM-IV, the ICD-10 has no specific category for depressive disorder in childhood, so diagnostic criteria developed for adult patients must be applied to children. However, a combination category for depression and conduct disorder is included in the ICD-10, depressive conduct disorder, for which the child must fulfill criteria for both depression and conduct disorder. 

The adverse effects of TCAs are also similar to those reported in adults (see Chapter 7). The secondary amine TCAs (e.g., desipramine, nortriptyline) are generally as well tolerated as newer antidepressants. Increased blood pressure may be more likely to occur in children than in adults but hypertension per se is rare ( 135). The most common cardiovascular effect is mild tachycardia. Despite their generally favorable adverse effect profile, secondary amine TCAs can cause serious toxicity in children and adolescents just as in adults when a taken in an overdose or when a high TCA plasma level occurs as a result of slow metabolism ( 136). For that reason, most clinicians reserve TCAs for the child or adolescent who has at least a moderate depressive disorder unresponsive to a trial of one or more newer antidepressants. In such instances, TDM should be done at least once to ensure plasma concentrations greater than 450 ng/mL do not develop ( 137). Such levels are associated with an increased risk of the following ... 

Kashani JH, Shekim WO, Reid JC. Amitriptyline in children with major depressive disorder. A double blind crossover pilot study. J Am Acad Child Psychiatry 1984 23 348-351. 

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. 

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. 

FIGURE 10—6. Depressive and anxious symptoms are not only a hallmark of major depressive disorder but are frequently associated with other psychiatric disorders, including bipolar disorder, schizophrenia, and schizoaffective disorder with organic causes of depression, such as substance abuse with childhood mood disorders (child) with psychotic forms of depression and with mood and psychotic disorders resistant to treatment with drugs (treatment-resistant), among others. 

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. 

Hughes, C.W. Emslie, G.J. Crismon, M.L. The Texas children s medication algorithm project Report of the Texas consensus conference panel on medication treatment of childhood major depressive disorder, J. Am. Acad. Child Adolesc. Psych. 1999, 38 (5), 517-528. 

There has been recent concern from unpublished data in industry-sponsored trials of SSRIs in child and adolescent depression suggesting that these drugs may lead to an increased rate of suicidal ideation. This prompted a review of their use by the UK Committee on Safety of Medicines (CSM) in 2003, which raled that for major depressive disorder (MDD) in children and adolescents under the age of 18 ... 

There are some people who would look at my situation and think my health problems were the result of a post-traumatic stress disorder, or depression or both. As a child I was abused, and nearly died from anorexia before the age of ten. 

Of greater concern is the safety of the TCAs. Toxic levels of these medications can produce lethal cardiac arrhythmias, seizures, and suppression of breathing. An overdose of a 1-2 week supply of most TCAs is often fatal, a serious consideration when prescribing medication to depressed patients with suicidal thoughts. Children taking imipramine for treatment of ADHD have died from sudden cardiac death consequently, child psychiatrists seldom use TCAs. Likewise, patients with heart disease or seizure disorders are more likely to have dangerous complications from TCAs and should avoid them. 

Warner V, Mufson L, Weissman MM (1995b) Offspring at high and low risk for depression and anxiety mechanisms of psychiatric disorder. J Am Acad Child Adolesc Psychiatry... 

Numerous studies found that childhood sexual, physical, and emotional abuse also predisposes victims of such abuse to the development of depression in adulthood (e.g., McCauley et ah, 1997). The risk for depression increases with early onset and severity of the abuse as well as with the experience of multiple types of abuse. In addition, child abuse is related to an array of anxiety disorders, including generalized anxiety disorder and PTSD (e.g., Kendler et ah, 2000). Other disorders related to childhood abuse include substance abuse, eating disorders, dissociation, and so-... 

Kaufman, J., Martin, A., King, R.A., and Charney, D.S. (2001) Are child-, adolescent- and adult-onset depression one and the same disorder Biol Psychiatry 49 980-1001. 

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