Sertraline for Major Depression in Children and Adolescents: Preliminary Clinical Experience

Objective: To evaluate the therapeutic and adverse effects of sertraline in children and adolescents with major depressive disorder (MDD). Method: Retrospective chart reviews were conducted on 33 youths (ages 8–18 years) treated for MDD with sertraline and no other psychotropic medication. Focusing on the interval from 2 to 10 weeks of treatment (when therapeutic changes were anticipated), clinical changes were assessed utilizing the Clinical Global Impression (CGI) subscales for severity of illness (modified to reflect severity of depressive illness) in 21 patients and for global improvement in 17 patients. Adverse effects were assessed in all 33 patients. Results: By the tenth week of treatment, the mean scores for severity of depressive illness changed significantly from 5.8 to 3.4 (6 = severely ill, 3 = mildly ill) and global improvement scores indicated that 11 of 17 patients (65%) improved much or very much. Older children improved to a greater degree. Mean dose was 1.6 mg/kg or 100 mg (range 25–200 mg) daily. No data were collected on which symptoms may have responded. Adverse effects were experienced by 16 of 33 patients, and 8 discontinued sertraline due to adverse effects. Seven patients (21%), including 4 of the 8 discontinuers, experienced behavioral side effects, whose onset clustered within the first 2 weeks and at 3 months of treatment. Two patients developed mania during sertraline treatment (one at 3 days, other at 94 days), and five developed other types of behavioral activation. No patient showed a worsening of depressive symptoms or an onset of suicidality or violence. Fatigue and sedation appeared to resolve spontaneously. Conclusion: These preliminary and uncontrolled clinical findings suggest that some children and adolescents with MDD may respond to sertraline, but adverse behavioral effects may be common.