TY - JOUR
T1 - Pharmacotherapy of Depressed Children and Adolescents
T2 - Current Issues and Potential Directions
AU - Vasa, Roma A.
AU - Carlino, Anthony R.
AU - Pine, Daniel S.
PY - 2006/6/1
Y1 - 2006/6/1
N2 - The recent deliberations by the U.S. Food and Drug Administration (FDA) regarding the relationship between antidepressants and suicidality in children have incited debates about the safety of these medications for the treatment of pediatric depression. In light of these events, this review discusses four issues pertaining to pharmacotherapy for pediatric depression. First, we summarize pertinent data from randomized controlled trials of antidepressants for pediatric depression. These data provide strong support for fluoxetine and modest support for the other antidepressants. Second, we examine the outcome of the FDA meta-analysis of the data on antidepressant-induced suicidality, with specific emphasis on the methodological limitations of this analysis. Third, we consider the collective implications of the antidepressant efficacy and suicidality data on clinical practice. Specifically, we present several compelling arguments that justify the continued use of antidepressants for pediatric depression, despite the inherent limitations of these medications. Finally, we review several pathophysiological factors that might provide insights into treatment response and impact the design of future pharmacotherapy studies of depression. These factors relate to diagnostic heterogeneity, developmental consistency, and psychobiology. Potentially novel pharmacotherapies are also discussed.
AB - The recent deliberations by the U.S. Food and Drug Administration (FDA) regarding the relationship between antidepressants and suicidality in children have incited debates about the safety of these medications for the treatment of pediatric depression. In light of these events, this review discusses four issues pertaining to pharmacotherapy for pediatric depression. First, we summarize pertinent data from randomized controlled trials of antidepressants for pediatric depression. These data provide strong support for fluoxetine and modest support for the other antidepressants. Second, we examine the outcome of the FDA meta-analysis of the data on antidepressant-induced suicidality, with specific emphasis on the methodological limitations of this analysis. Third, we consider the collective implications of the antidepressant efficacy and suicidality data on clinical practice. Specifically, we present several compelling arguments that justify the continued use of antidepressants for pediatric depression, despite the inherent limitations of these medications. Finally, we review several pathophysiological factors that might provide insights into treatment response and impact the design of future pharmacotherapy studies of depression. These factors relate to diagnostic heterogeneity, developmental consistency, and psychobiology. Potentially novel pharmacotherapies are also discussed.
KW - Major depression
KW - clinical trials
KW - pediatric, antidepressants
UR - http://www.scopus.com/inward/record.url?scp=33744915254&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33744915254&partnerID=8YFLogxK
U2 - 10.1016/j.biopsych.2005.10.010
DO - 10.1016/j.biopsych.2005.10.010
M3 - Review article
C2 - 16406250
AN - SCOPUS:33744915254
SN - 0006-3223
VL - 59
SP - 1021
EP - 1028
JO - Biological psychiatry
JF - Biological psychiatry
IS - 11
ER -