New-generation antidepressants, suicide and depressed adolescents: how should clinicians respond to changing evidence? Aust N Z J Psychiatry

Adolescent Service, Prince of Wales Hospital, Randwick, Australia. m.dud
Australian and New Zealand Journal of Psychiatry (Impact Factor: 3.77). 07/2008; 42(6):456-66. DOI: 10.1080/00048670802050538
Source: PubMed

ABSTRACT The purpose of the present paper was to identify, from the voluminous literature on efficacy and safety in new-generation antidepressants (NGAs) with depressed children and adolescents, practical clinical strategies for acute phase treatment. To this end a pragmatic survey of studies and reviews was undertaken. Meta-analyses of randomized controlled trials of NGAs in depressed children and adolescents have noted a comparative lack of efficacy, and a weak but statistically significant increased risk of self-harm and suicidal thoughts. But NGA prescription rates and youth suicide rates are generally inversely related, and ensuing 'black box' warnings about NGAs, by deterring NGA prescribing, have possibly contributed to rising youth suicide rates. In moderate-severe depression, benefits for fluoxetine and possibly other NGAs demonstrably outweigh risks. NGAs are not present in adolescents who die by suicide. Concern about NGA risks must be balanced against risks of non-treatment. While mild depression entails regular review, psychoeducation, self-care strategies and psychological interventions, NGAs should be administered concurrently with psychological treatments if depression is moderate- to severe, or if mild depression persists. Patients should be warned about off-label status of NGAs in depression, serious side-effects such as 'activation', suicidality, emotional blunting and manic switches, the need for adherence and avoiding abrupt discontinuation. They should be monitored early and regularly. Better evidence is required regarding psychological treatments, clinical course, and clinical practice trends. In moderate-severe depression the risk of suicide if NGAs are not used may outweigh any risk of self-harm associated with them.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Analyzed English and Welsh patient statistics and symptomatological surveys. It is argued that these data do not provide adequate grounds for conclusions. The overrepresentation of females among the mentally ill is relatively recent and is a function of which disturbances are considered mental illness and of marital status. It is pointed out that among single persons (who have the highest rate of hospitalization) males predominate, whereas among married persons (the majority of patients) females have higher rates. In Britain, one reason for the female preponderance is the number of patients over 65 yrs of age, most of whom are female. It is contended that the true prevalence of sex differences in mental illness cannot be determined because sex bias is built into the diagnostic criteria; epidemiological studies should be evaluated with caution because psychiatric classification is a function of historical and social forces. (32 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    International Journal of Mental Health 01/1982; 11:46-66.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The non-OCD (obsessive-compulsive disorder) anxiety disorders in the pediatric population- separation anxiety disorder, generalized anxiety disorder, and social phobia and others- are arguably the most common psychiatric disorders in this age group. Anxiety disorders, in addition to being common, also significantly impair the affected child at home, school, and with peers. A small developing evidence base suggests the selective serotonin reuptake inhibitors (SSRIs) are the pharmacological treatment of choice for pediatric non-OCD anxiety disorders. In clinical trials, SSRIs are often very effective in reducing symptoms and improving functioning and generally well tolerated. The U.S. Food and Drug Administration's (FDA) review of the safety of antidepressants in the pediatric population suggest a small, but significant, increased relative risk for suicidality adverse events on antidepressant versus placebo. Despite the apparent increased risk, the larger magnitude of benefit of the SSRIs for pediatric non-OCD anxiety disorders compared to depression suggests the benefit/risk ratio for anxiety disorders is more favorable than that for depression. This paper will review available studies on the treatment of non-OCD childhood anxiety disorders with antidepressants, including the SSRIs, and discuss pertinent safety issues.
    Journal of Child and Adolescent Psychopharmacology 03/2006; 16(1-2):171-9. DOI:10.1089/cap.2006.16.171 · 3.07 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The present work represents a detailed description of our current understanding and knowledge of the epidemiology, etiopathogenesis and clinical manifestations of mood disorders, their comorbidity and overlap, and the effect of variables such as gender and age. This review article is largely based on the 'Mood disorders' chapter of the Wikibooks Textbook of Psychiatry
    Annals of General Psychiatry 04/2010; 9:14. DOI:10.1186/1744-859X-9-14 · 1.53 Impact Factor
Show more