Children major depressive disorder

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. 

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. 

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. 

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 ... 

Goodyer, I.M., Herbert, J., Secher, S.M., and Pearson, J. (1997) Short-term outcome of major depression I. Comorbidity and severity at presentation as predictors of persistent disorder. / Am Acad Child Adolesc Psychiatry 36 179-187. 

Daviss, WB. (1999) Efficacy and tolerability of burproprion in boys with ADHD and major depression or dysthymic disorder. Child Adolesc Psychopharmacol Update 1(5) 1,6. 

Classic reactive depressions (sometimes referred to as psychological depressions) can range in intensity from mild or moderate (for example, adjustment disorders with depressed mood) to severe (major depression). These disorders occur in response to identifiable psychosocial stressors. These stressors may be acute and intense (such as loss of a loved one), insidious (as in the case of a gradual deterioration in the quality of marital relationship), or in the distant past (for example, the emotions experienced by a survivor of child abuse who in adulthood begins to recall long-forgotten abusive events). 

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