Antidepressants In Adolescents Research Articles

Uso de Antidepressivos em Adolescentes: uma Revisão Sistemática da Literatura

In recent years, the number of young people diagnosed with depression has grown, and consequently there has been an increase in the consumption of psychotropic drugs, with the need to monitor the patient's needs, together with applied pharmacotherapy, aimed at improving the patient's health. Therefore, this research aims to carry out a systematic review on the use of antidepressants in adolescents. A survey of studies published in scientific databases was carried out, including Google Scholar, the Virtual Health Library and the Scientific Electronic Library Online, following the PRISMA method. After applying the inclusion and exclusion criteria, 6 studies were selected to compose the review. The results were presented according to the symptoms associated with depression; therapy and treatment with psychotropic drugs; the side effects of psychotropic drugs; and the role of the pharmacist in the therapeutic management of adolescents with depression. It is concluded that pharmacological therapy should be based on the symptoms presented by each client, therefore, in the different studies described, there was a discrepancy between the drugs prescribed for the treatment of patients, after all, the disorder occurs in different ways depending on each individual., as they result from the influence of external and internal factors.

Effect of the FDA Black Box Suicidality Warnings for Antidepressants on Suicide Rates in the USA.

Background: Some authors claimed that the US Food and Drug Administration (FDA) black box warning on treatment-emergent suicidality with antidepressants in adolescents (issued 2004) and young adults (issued 2006) led to an increase of suicides, based on the analyses of ecological data with debatable assumptions about putative changes in suicide rates. Aims: To explore if putative changes in suicide rates in adolescents and young adults at the time of the FDA warnings is a detectable signal in the data or compatible with random fluctuations. Method: We applied different changepoint analyses for adolescent and young adult suicide rates from 1981 to 2019 in the USA. Results: Changepoint analysis did not support a detrimental effect of the FDA black box warnings. The downward trend of suicides reversed several years after the warning in adolescents (2007-2009) and many years before in young adults (1999-2001). Limitations: Our analyses cannot rule out detrimental effects of the FDA warnings. However, even if there was such an effect, it was likely small and indistinguishable from random fluctuations in the available suicide data. Conclusion: There is no detectable change of trend in adolescent or young adult suicide rates in line with a detrimental effect of the FDA black box warnings on treatment-emergent suicidality.

1.63 EVALUATING ADHERENCE TO ANTIDEPRESSANTS IN ADOLESCENT OUTPATIENTS WITH DEPRESSIVE DISORDER

Adherence to medication is one of the most important factors in the treatment of depression. In our study, we examined the difference in adherence to antidepressants in adolescents as estimated by various methods and pinpointed clinical factors that influence treatment adherence in adolescent depressive disorder.

Using acute tryptophan depletion to investigate predictors of treatment response in adolescents with major depressive disorder: study protocol for a randomised controlled trial

BackgroundSelective serotonin reuptake inhibitors (SSRIs) are amongst the most prescribed antidepressants for adolescents with depressive symptoms and major depressive disorder. However, SSRIs have significant shortcomings as a first-line treatment considering that not all patients respond to these antidepressants. Amongst paediatric populations, meta-analyses indicate that up to approximately 40% of patients do not respond, and for those who do show benefit, there is substantial heterogeneity in response onset. The neurotransmitter serotonin (5-HT) plays a role in the clinical effectiveness and mechanisms of action of SSRIs. However, the exact and complete mechanism of action and reasons for the low response rate to SSRIs in some adolescent populations remains unknown.MethodsTo examine SSRI response and the role of 5-HT, this study will employ a randomised double-blind within subject, repeated measures design, recruiting adolescent patients with major depressive disorder. Participants will be subjected to acute tryptophan depletion (ATD) and the balanced control condition on two separate study days within a first study phase (Phase A), and the order in which these conditions (ATD/balanced control condition) occur will be random. This phase will be followed by Phase B, where participants will receive open label pharmacological treatment as usual with the SSRI fluoxetine and followed-up over a 12-week period.DiscussionATD is a neurodietary method typically used to investigate the impact of lowered brain 5-HT synthesis on mood and behaviour. The major hypothesis of this study is that ATD will be negatively associated with mood and cognitive functioning, therefore reflecting individual serotonergic sensitivity and related depressive symptoms. Additionally, we expect the aforementioned effects of ATD administration on mood to predict clinical improvement with regard to overall depressive symptomatology 12 weeks into SSRI treatment.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616001561471. Registered on 11 November 2016.

Must we fear antidepressants in adolescents?

IntroductionEpidemiological studies have established that teenager's prevalence rates of major depression are significant (10%). The media has given a good deal of attention to the potential risks of antidepressants and their connection to increased suicidality (especially in children and adolescents). These concerns have had a significant impact on both the prescribing of antidepressants and the parental fears about their use. It is interesting to note that in large groups’ studies of adolescents treated with selective serotonin reuptake inhibitors there have been no evidence of increased suicidal risk.ObjectiveUnderstand if there is a significant association between antidepressant treatment and suicidality in a 3-months follow-up study of the adolescent's consultation of Centro Hospitalar Lisboa Norte.MethodsAnalysis of 81 adolescents with an initial diagnosis of major depression treated with an antidepressant for at least 3 months.ResultsAfter the follow-up period there has been an improvement in sadness in 92.6% of the adolescents, a remission of death thoughts in 98.8% and an absence of suicides attempts. In 61.7%, it was necessary to introduce also an antipsychotic in a low dose and in 12.3% another antidepressant with a hypnotic effect.ConclusionIt is clear that untreated major depression carries significant suffering and disability. Although treatment with antidepressants may take several weeks before clinical improvement appear and depression may worsen in the first days, its therapeutic effect should not be underestimated even if becomes necessary to add another medication in the first days. In evaluating these kinds of concerns, we must always differentiate between media hype and scientific data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

New screening and treatment guidelines for adult and adolescent depression

Almost 7% of U.S. adults have major depressive disorder. The leading cause of disability in high-income countries, depression is linked to higher mortality rates due to suicide and an inability to manage other health conditions. About 8% of adolescents have major depressive disorder, a precursor to recurrent bouts with the condition in adulthood. Depression at this age can affect schoolwork and relationships with family and peers and point to a greater risk for other mental health conditions and suicide later in life. The impact of depression on public health and individual quality of life prompted USPSTF earlier this year to release new recommendations on the screening of adults and adolescents for depression. In close succession to the new recommendations were new clinical guidelines on treatment of depression in adults and a warning about potential risks of antidepressants in adolescents. “The update to screening recommendations is a perfect opportunity for pharmacists to step up and identify people for further evaluation and treatment,” said Stephen Saklad, PharmD, BCPP, director of the psychiatric pharmacy program at University of Texas Health Science Center at San Antonio.

Poisonings requiring admission to the pediatric intensive care unit: A 5-year review

Background. Poisonings represent a significant number of preventable admissions to the pediatric intensive care unit (PICU), but data about poisonings requiring PICU-level care are limited. Objectives. To identify the demographics of patients admitted with poisonings and characterize their clinical courses related to their poisoning. Methods. All poisonings over a 5-year period (2008–2012) at an academic medical center in New England were retrospectively reviewed using electronic medical records in an observational case series. Poisonings were identified using key search terms within an admissions database. Results. There were 273 admissions for poisonings, which represent 8% of total PICU admissions over this time period. The poisonings were unintentional in 148 (54%) cases and intentional in 125 (46%). The vast majority of poisonings occurred in patients either 3 years or below (N = 121, 44%) or 13 years or above (N = 124, 45%). Most (96%) admissions were for less than 48 h and 41% were for less than 24 h. Mean PICU length of stay was 1.2 + 0.7 days. A total of 468 substances were ingested in 54 different drug classes, with analgesics and antidepressants being the most common. Eighty-five (31%) poisonings were polypharmaceutical. The most commonly used therapies were naloxone, activated charcoal, and benzodiazepines. Twenty-seven patients (10%) received mechanical ventilation. There was one fatality, an adolescent with a polypharmacy overdose in a suicide attempt. Conclusion. Pediatric poisonings are a significant percentage of admissions to the PICU. The majority of poisonings are non-fatal, require supportive care, close monitoring, and some specific treatment. Drug classes causing poisonings have changed to a higher percentage of opioids in younger patients and atypical antidepressants in adolescents.

A Primate Model of the Effects of Childhood Antidepressant Treatment

A Primate Model of the Effects of Childhood Antidepressant Treatment

Out of the Black Box: Treatment of Resistant Depression in Adolescents and the Antidepressant Controversy

The purpose of this article is to describe the effects of the pediatric antidepressant controversy on the Treatment of Serotonin-Selective Reuptake Inhibitor (SSRI) Resistant Depression in Adolescents (TORDIA) trial. Adolescents, ages 12-18 years, with SSRI resistant depression were randomized to one of four treatments for a 12 week trial: Switch to different SSRI, switch to an alternate antidepressant (venlafaxine), switch to an alternate SSRI plus cognitive behavior therapy (CBT), or switch to venlafaxine plus CBT. The health advisories and "black box" warnings regarding suicidality and antidepressants in adolescents occurred during the course of the TORDIA trial. Revisions to the protocol, multiple-consent form changes, and re-consenting of patients were necessary. Recruitment of participants was adversely affected. Despite a cascade of unforeseen events that delayed the completion of the study, the TORDIA trial resulted in clinically important information about treatment-resistant depression in adolescents.

Is cognitive behavioural therapy an effective complement to antidepressants in adolescents? A meta-analysis.

Evidence on effectiveness of combined treatments versus antidepressants alone in adolescents consists on a few studies in both major depressive and anxiety disorders. A meta-analysis of randomised 12-week follow-up studies in which antidepressant treatment was compared to combined treatment consisting of the same antidepressant with cognitive behavioural therapy has been performed. Data were entered into the Cochrane Collaboration Review Manager software and were analysed within a random effect framework. A quality assessment has been performed through Jadad Scale. Higher global functioning at the Children's Global Assessment Scale was found in the combined treatment group (p < 0.0001) as well as higher improvement at the Clinical Global Impressions Improvement Scale (p = 0.04). No benefit of combined treatment was found on depressive symptomatology at the Children's Depression Rating Scale - Revised. Combined treatment seems to be more effective than antidepressant alone on global functioning and general improvement in adolescents with major depressive and anxiety disorders.

Evaluation of Comparative Treatment Trials

HE EVALUATION OF THE COMPARATIVE EFFECTIVENESS of treatments should not depend on the statistical effect of treatments on individual measures of outcome (benefits or harms), but rather on the clinical effects of treatments (both benefits and harms) on individual patients who experience both benefits and harms. Such evaluation requires both statistical assessment of the rates of cooccurrence of such benefits and harms and clinical assessment of their combined clinical effects on patients. Randomized clinical trials (RCTs), carried out appropriately, have the potential to move research rapidly toward personalized medicine. 1 However, to do this, RCT methodology must be updated. Several such updates already exist, some to promote optimal use of existing RCT methods (RCT registration, 2 CONSORT guidelines 3 ) and others to modify and extend their clinical significance (effect sizes) rather than statistical significance (P values) 4 or moderators of treatment choice. 5 However, all of these advances depend crucially on the quality of the RCT outcomes. RCTs should consider outcomes at the patient level, taking into account the simultaneous benefits and harms experienced by each patient, much as a physician does when deciding between 2 treatment options. Information on benefit alone is useful only if potential harms are of no clinical importance and vice versa. For instance, there is concern that use of selective serotonin reuptake inhibitor antidepressants in adolescents may increase the risk of suicidal ideation and suicidality. 6 If only benefits are considered, a small subgroup of young patients may be exposed to serious harm; however, if only harms are considered, other patients may be denied a potentially lifesaving treatment. Methods for assessing clinical effects of interventions on patients rather than on measures are already available, and better methods can be developed, but this type of information must be demanded of RCTs.

Using a preclinical approach to reveal potential mechanisms of ADRs to antidepressants in adolescents

A recent meta-analysis of the efficacy of all types of antidepressants in juvenile major depressive disorder patients [1] urged that additional research be undertaken to clarify the basis of limited responses in adolescents and children to antidepressant treatments considered standard in the treatment of adult major depressive disorder (MDD). Sprague-Dawley rats were treated chronically with fluoxetine, imipramine, tranylcypromine or vehicle control. Total RNA was extracted from brain cortices, cRNA was fragmented and hybridised to Affymetrix Rat Genome 230 2.0 microarrays. A total of 24 microarrays were analysed (ie, 6 biological replicates in 4 treatment groups) and information on the probesets of interest was obtained using different websites. Taqman real-time qPCR methodology was used to validate the transcripts identified from the microarray data-analysis as the most significantly differentially expressed in response to treatment with imipramine or fluoxetine compared to vehicle. The relative expression of each gene was also determined. In both the imipramine- and fluoxetine-treated animals, expression of several genes was altered. These function in signal transduction (e.g., angiopoietin-like 4 protein), protein metabolism (e.g., sulfotransferase family 1A, phenol-preferring, member 1), cell survival (e.g., response gene to complement 32, metallothionein 1a), and nuclear functions (e.g., similar to Cat eye syndrome critical region protein 2). Therefore, in the developing rodent cortex, antidepressants alter the expression of genes involved in signalling, cellular survival and protein metabolism, involved in critical functions including neuronal plasticity. These findings have implications for the mechanisms of ADRs to antidepressants in children and adolescents.

Review of the efficacy and safety of antidepressants in youth depression

Depression in children and adolescents is a cause of substantial morbidity and mortality in this population. It is a common disorder that affects 2% of children and up to 6% of adolescents. Although antidepressants are used frequently for the treatment of this disorder, there has been recent controversy about the efficacy and safety of these medications in this population. This review examined the available evidence from clinical trials of antidepressants in adolescents and children with depression. Clinical trial data reviewed were obtained from published reports, including peer review journals and meeting abstracts, as well as unpublished data in the public domain. Clinical trials in this review included large RCTs of antidepressants in youth under the age of 19 with depression. Studies were identified in 2 stages: 1) all RCTs included in the 2004 FDA safety report were reviewed; and 2) to ensure that no additional studies not reported to the FDA were missed, MEDLINE and PSYCH Info were searched from inception until December 2004. A total of 8 published studies and 9 unpublished studies were identified and reviewed. Efficacy and safety results from each study are reviewed in detail. There are significant differences in remission and response rates between different antidepressants but also between placebo groups across studies. Adverse events are common in clinical trials involving children and adolescents with depression. Due to lack of access to full data sets, effect sizes could not be calculated. With the variability in trial methodology and the variation in the drug/placebo response rates within a single trial, clinicians need to be judicious in their interpretation of research data on pediatric antidepressant trials. Significant methodological issues may also have affected the efficacy and safety results from these clinical trials.

204. Use of anti-depressants in adolescents with cystic fibrosis

204. Use of anti-depressants in adolescents with cystic fibrosis

LSD flashback syndrome exacerbated by selective serotonin reuptake inhibitor antidepressants in adolescents

Two adolescents with a long history of abuse of lysergic acid diethylamide (LSD) and symptoms consistent with major depressive disorder, on initiation of antidepressant therapy with selective serotonin reuptake inhibitor agents, had the new onset or worsening of LSD flashback syndrome. The similarity in neuroreceptor physiology for both LSD and serotonin suggests that the LSD flashback syndrome may be induced by these drugs in patients with a history of LSD abuse. (J PEDIATR 1994;125:817-9)

The Pharmacotherapy of Depressive Illness in Adolescence: III. Diagnostic and Conceptual Issues in Studies of Tricyclic Antidepressants

ABSTRACT In current pharmacological treatment studies, diagnostic subgroups vary appreciably in phenomenological characteristics, biological dysfunctions, and illness severity. In adults, a variety of diagnostic conditions as well as concurrent psychological and social features, medical disorders, and personality disorders have been proposed to be predictors of weak responsivity to tricyclic antidepressants. Such clinical and diagnostic predictors of treatment response in adults may be applied heuristically in adolescents; however, whether or not these features have the same predictive significance in adolescents is not known. Further, the onset, course, and treatment responsivity of depressive disorders may be more intimately affected by naturally occurring maturational processes in adolescents than in adults. Until pharmacological studies in adolescents address these conceptual and diagnostic problems, we cannot reasonably infer any firm knowledge about the alleged inefficacy of tricyclic antidepressants in adolescents. Without adequate inclusionary and exclusionary criteria, developed in adolescent populations, samples may be studied (and patients may be treated) who have a high likelihood of placebo response or refractoriness to antidepressant treatment.