Selective serotonin reuptake inhibitors in children and adolescents

Garland, E.J. and Baerg, E.A. (2001) Amotivational syndrome associated with selective serotonin reuptake inhibitors in children and adolescents. / Child Adolesc Psychopharmacol 11 181-186. 

Leonard, H.L., March, J., Rickler, K.C., and Allen, A.J. (1997) Review of the pharmacology of the selective serotonin reuptake inhibitors in children and adolescents. J Am Acad Child Adolesc Psychiatry 36 725—736. 

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. 

Despite the diagnostic challenges that remain in trying to understand the nature of MDD in children and adolescents, advances in its treatment has progressed considerably since the last edition of this textbook. Over this interval, selective serotonin reuptake inhibitors (SSRIs) have superseded TCAs as the treatment of first choice based both on efficacy and safety considerations. As in adults, specific psychotherapies (cognitive therapy, cognitive-behavioral therapy, and interpersonal therapy) may be as effective as antidepressant medication, at least in mild to moderate depression in children and adolescents ( 111, 112). Also, evidence indicates that depression in children and adolescents may be more influenced than is depression in adults by psychosocial variables such as peers and family, as well as other environmental factors (113). 

Wilens, T., Biederman, J., Kwon, A., Chase R., Greenberg, L., Mick, E., et al. (2003). A systematic chart review of the nature of psychiatric adverse events in children and adolescents treated with selective serotonin reuptake inhibitors. Journal of Child and Adolescent Psychopharmacology, 13, 143-152. 

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. 

Metabolic and cardiovascular adverse events were further studied by the same authors in the same sample of children and adolescents [7 ]. Compared with the controls, the treated cohort had a higher prevalence of obesity (OR = 2.1), type 2 diabetes mellitus (OR = 3.2), cardiovascular conditions (OR = 2.7), and orthostatic hypotension (OR = 1.6). In the treated cohort, those who had been exposed to multiple antipsychotic drugs had a significantly higher risk of incident obesity/weight gain (OR = 2.3), type 2 diabetes mellitus (OR = 2.4), and dyslipidemia (OR = 5.3). Incident cardiovascular events were more likely with the use of conventional antipsychotic drugs (OR = 4.3) and mood stabilizers (OR = 1.3). Incident orthostatic hypotension h os more prevalent in those co-prescribed selective serotonin reuptake inhibitors (OR = 1.8) and mood stabilizers (OR = 1.3). 

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