SSRI adverse events: How to monitor and manage

Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA.
International Review of Psychiatry (Impact Factor: 1.8). 05/2008; 20(2):203-8. DOI: 10.1080/09540260801889211
Source: PubMed


Antidepressants are efficacious for pediatric major depressive disorder, obsessive compulsive disorder (OCD), and non-OCD anxiety disorders. Antidepressants should be used in an evidence-based fashion, with frequent monitoring for side effects, especially when initiating treatment and adjusting dosage. With diligence to appropriate prescribing and monitoring, the benefits of therapy outweigh the potential of treatment related risk.

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    • "Additionally, combined CBT and SRI pharmacotherapy also is a promising treatment approach, especially for youth with severe OCD symptoms (POTS 2004). However, CBT alone is recommended for children with mild to moderate symptoms because of untoward effects (e.g., behavioral activation, agitation, irritability, suicidal ideation) that can occur during pharmacological treatment (Murphy et al. 2008; POTS 2004). Additionally, the availability of trained CBT therapists is limited and increasing access to them remains an important salient issue. "
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    ABSTRACT: Pediatric obsessive–compulsive disorder (OCD) is a common psychiatric disorder that impairs children’s functioning in home, school, and community settings. Once thought to be an untreatable or treatment refractory disorder, evidence-based treatments now exist for pediatric OCD. Various psychological treatment approaches for pediatric OCD have been investigated and research supports the use of cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) and combined CBT/E/RP with serotonin reuptake inhibitor pharmacotherapy. This paper reviews these approaches and highlights the prominent role of CBT/E/RP as a first-line treatment for pediatric OCD.
    Full-text · Article · Dec 2012 · Journal of Contemporary Psychotherapy
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    • "Restrictive bariatric surgery has also not been effective in reducing hyperphagia or long-term weight reduction and has been associated with increased morbidity and mortality.128 Serotonin agonists (SSRIs) have been the most successful in reducing temper outbursts and improving compulsivity in PWS.129,130 Serotonin imbalance has been linked to repetitive behavior, obsessive and compulsive behavior, depression, anxiety, and self-injurious behavior in the non-PWS population.131 Holland and colleagues,23 through factor-analysis, found that skin-picking and mood swings were related and thus could have a common underlying etiologic mechanism. "
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    ABSTRACT: Prader-Willi syndrome (PWS) is a complex neurodevelopmental disorder caused by an abnormality on the long arm of chromosome 15 (q11-q13) that results in a host of phenotypic characteristics, dominated primarily by hyperphagia and insatiable appetite. Characteristic behavioral disturbances in PWS include excessive interest in food, skin picking, difficulty with a change in routine, temper tantrums, obsessive and compulsive behaviors, and mood fluctuations. Individuals with PWS typically have intellectual disabilities (borderline to mild/moderate mental retardation) and exhibit a higher overall behavior disturbance compared to individuals with similar intellectual disability. Due to its multisystem disorder, family members, caregivers, physicians, dieticians, and speech-language pathologists all play an important role in the management and treatment of symptoms in an individual with PWS. This article reviews current research on behavior and cognition in PWS and discusses management guidelines for this disorder.
    Full-text · Article · May 2010 · Neuropsychiatric Disease and Treatment
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    • "Despite practice parameter guidelines that suggest that children and adults with OCD be treated initially with CBT alone or in conjunction with an SRI (POTS 2004), SRI therapy alone is widely used as the initial approach to OCD management. A primary advantage of SRIs is their ease of dissemination relative to CBT; however, their first-line use as a monotherapy is generally not indicated due to modest efficacy and concerns related to side effects (e.g., Goodman et al. 1997; Murphy et al. 2008). Additionally, clinical remission to SRI monotherapy is rare (see Geller et al. 2003 for a review) and most youth continue to have symptoms following an adequate course of SRI therapy. "
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    ABSTRACT: This paper discusses a recent translational success in combining behavioral psychotherapy with a novel medication, d-cycloserine (DCS), to augment cognitive-behavioral therapy (CBT) for anxiety disorders. The literature on behavioral theory of exposure-based therapies is provided, followed by a discussion of the role of DCS in enhancing extinction learning that is core to such therapies. As well, pragmatic issues such as dosing and timing are discussed. The manuscript is concluded with consideration of future directions in DCS augmentation in the form of a pilot trial investigating DCS augmentation of CBT in pediatric patients with obsessive-compulsive disorder. KeywordsOCD-Children-Augmentation-D-Cycloserine-Cognitive-behavioral therapy
    Full-text · Article · Apr 2010 · Child and Youth Care Forum
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