Antidepressant Therapy in Children and Adolescents

An Overview for the Generalist
  • Domenic A. Ciraulo
  • Danielle M. Ciraulo
  • Glenn Saxe
Chapter

Abstract

In this chapter, we present an overview of antidepressant pharmacotherapy for depressive disorders in children and adolescents. Our intended audience is the generalist, who may be called on to treat older adolescents for whom the demarcation between adulthood and adolescence may not be clear-cut. From the vantage point of the clinical psychopharmacologist who treats adults, several areas require special attention in adolescents, including (a) recognition, diagnosis, and differential diagnosis; (b) selection of the psychosocial intervention used with pharmacotherapy; (c) dosing strategies based on pharmacokinetics and pharmacodynamics; (d) pharmacotherapy in the context of common comorbid conditions; and (e) duration of antidepressant therapy. One of the most startling differences between the fields of adult and childhood antidepressant therapy is the relative paucity of research data from clinical trials in children that can be used to make informed clinical decisions.

Keywords

Anxiety Disorder Major Depression Major Depressive Disorder Antidepressant Therapy Adolescent Depression 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Birmaher B, Ryan ND, Williamson DE, et al. Childhood and adolescent depression: a review of the past 10 years: Part I. J Am Acad Child Adolesc Psychiatry 1996; 35: 1427–1439.PubMedCrossRefGoogle Scholar
  2. 2.
    Lewinsohn PM, Clarke GN, Seeley JR, Rohde P. Major depression in community adolescents: age at onset, episode duration, and time to recurrence. J Am Acad Child Adolesc Psychiatry 1994; 33: 809–818.PubMedCrossRefGoogle Scholar
  3. 3.
    Kashani JH, McGee RO, Clarkson SE, et al. Depression in a sample of 9-year-old children: prevalence and associated characteristics. Arch Gen Psychiatry 1983; 40: 1217–1223.PubMedCrossRefGoogle Scholar
  4. 4.
    Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. J Am Acad Child Adolesc Psychiatry 1996; 35: 865–877.PubMedCrossRefGoogle Scholar
  5. 5.
    Klerman GL, Weissman MM. Increasing rates of depression. JAMA 1989; 261: 2229–2235.PubMedCrossRefGoogle Scholar
  6. 6.
    Weissman MM, Wolk S, Goldstein RB, et al. Depressed adolescents grown up. JAMA 1999; 281: 1707–1713.PubMedCrossRefGoogle Scholar
  7. 7.
    Hughes CW, Emslie GJ, Crismon ML, et al. The Texas Children’s Medication Algorithm Project: report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. J Am Acad Child Psychiatry 1999; 38: 1442–1454.CrossRefGoogle Scholar
  8. 8.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  9. 9.
    Melnyk BM, Moldenhauer Z. Current approaches to depression in children and adolescents. Adv Nurse Pract 1999; 7: 24–29, 97.Google Scholar
  10. 10.
    Kaufman J, Martin A, King RA, Charney D. Are child-, adolescent-, and adult-onset depression one and the same disorder? Biol Psychiatry 2001; 49: 980–1001.PubMedCrossRefGoogle Scholar
  11. 10a.
    Levitt P. Structural and functional maturation of the developing primate brain. J Pediatr 2003; 143: S35–S45.PubMedCrossRefGoogle Scholar
  12. 10b.
    del Olmo E, Pazos A. Aminergic receptors during the development of the human brain: the contribution of in vitro imaging techniques. J Chem Neuroanat 2001; 22: 101–114.PubMedCrossRefGoogle Scholar
  13. 10c.
    Nguyen L, Rigo J-M, Rocher V, et al. Neurotransmitters as early signals for central nervous system development. Cell Tissue Res 2001; 305: 187–202.PubMedCrossRefGoogle Scholar
  14. 10d.
    Goldman-Rakic PS, Brown PM. Postnatal development of monoamine content and synthesis in the cerebral cortex of rhesus monkeys. Brain Res 1982; 256: 339–349.PubMedGoogle Scholar
  15. 10e.
    Lesch KP. Variation of serotonergic gene expression: neurodevelopment and the complexity of response to psychopharmacologic drugs. Eur Neuropsychopharmacol 2001; 11: 457–474.PubMedCrossRefGoogle Scholar
  16. 10f.
    Nicotra A, Pierucci F, Parvez H, Senatori O. Monoamine oxidase expression during development and agin. Neurotoxicology 2004; 25: 155–165.PubMedCrossRefGoogle Scholar
  17. 10g.
    Davidson RJ, Slagter HA. Probing emotion in the developing brain: functional neuroimaging in the assessment of the neural substrates of emotion in normal and disordered children and adolescents. Ment Retard Dev Disabil Res Rev 2000; 6: 166–170.PubMedCrossRefGoogle Scholar
  18. 10h.
    Steingard RJ, Yurgelum-Todd DA, Hennen J, et al. Increased orbitofrontal cortex levels of choline in depressed adolescents as detected by in vivo proton magnetic resonance spectroscopy. Biol Psychiatry 2000; 48: 1053–1061.PubMedCrossRefGoogle Scholar
  19. 10i.
    Farchione TR, Moore GJ, Rosenberg DR. Proton magnetic resouncance spectroscopic imagin in pediatric major depression. Biol Psychiatry 2002; 52: 86–92.PubMedCrossRefGoogle Scholar
  20. 11.
    Jellinek MS, Snyder JB. Depression and suicide in children and adolescents. Pediatr Rev 1998; 19: 255–264.PubMedCrossRefGoogle Scholar
  21. 11a.
    Birmaher B, Ryan ND, Williamson DE, Brent DA. Kaufman J, Dahl RE, et al. Childhood and adolescent depression: a review of the past 10 years. Part 1. J Am Acad Child Adolesc Psychiatry 1996; 35: 1427–1439.PubMedCrossRefGoogle Scholar
  22. 11b.
    Birmaher B, Brent D, et al. Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 1998; 37 (suppl 10): 63S - 82S.CrossRefGoogle Scholar
  23. 11c.
    Evans WE, Relling MV, Petros WP, Meyer WH, Mirro J, Jr., Crom WR. Dextromethorphan and caffeine as probes for simultaneous determination of debrisoquin–oxidation and N– acetylation phenotypes in children. Clin Pharmacol Ther 1989; 45: 568–573.PubMedCrossRefGoogle Scholar
  24. 12.
    Leeder JS, Kearns GL. Pharmacogenetics in pediatrics. Implications for practice. Pediatr Clin North Am 1997; 44: 55–77.PubMedCrossRefGoogle Scholar
  25. 13.
    Relling MV, Lin JS, Ayers GD, Evans WE. Racial and gender differences in Nacetyltransferase, xanthine oxidase, and CYP1A2 activities. Clin Pharmacol Ther 1992; 52: 643–658.PubMedCrossRefGoogle Scholar
  26. 14.
    Leeder JS. Pharmacogenetics and pharmacogenomics. Pediatr Clin North Am 2001; 48: 765–781.PubMedCrossRefGoogle Scholar
  27. 15.
    Wilens TE, Cohen L, Biederman J, et al. Fluoxetine pharmacokinetics in pediatric patients. J Clin Psychopharmacol 2002; 22: 568–575.PubMedCrossRefGoogle Scholar
  28. 16.
    Findling RL, Reed MD, Myers C, et al. Paroxetine pharmacokinetics in depressed children and adolescents. J Am Acad Child Adolesc Psychiatry 1999; 38: 952–959.PubMedCrossRefGoogle Scholar
  29. 17.
    Alderman J, Wolkow R, Chung M, Johnston HF. Sertraline treatment of children and adolescents with obsessive-compulsive disorder or depression: pharmacokinetics, tolerability, and efficacy. J Am Acad Child Adolesc Psychiatry 1998; 37: 386–394.PubMedCrossRefGoogle Scholar
  30. 18.
    Carlsson B, Olsson G, Reis M, et al. Enantioselective analysis of citalopram and metabolites in adolescents. Ther Drug Monit 2001; 23: 658–664.PubMedCrossRefGoogle Scholar
  31. 19.
    Cohen LG, Biederman J, Wilens TE, et al. Desipramine clearance in children and adolescents: absence of effect of development and gender. J Am Acad Child Adolesc Psychiatry 1999; 38: 79–85.PubMedCrossRefGoogle Scholar
  32. 20.
    Findling RL, Preskorn SH, Marcus RN, et al. Nefazodone pharmacokinetics in depressed children and adolescents. J Am Acad Child Adolesc Psychiatry 2000; 39: 1008–1016.PubMedCrossRefGoogle Scholar
  33. 21.
    Birmaher B, Brent DA, Benson RS. Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 1998; 37: 1234–1238.PubMedCrossRefGoogle Scholar
  34. 22.
    Ambrosini PJ, Wagner KD, Biederman J, et al. Multicenter open-label sertraline study in adolescent outpatients with major depression. J Am Acad Child Adolesc Psychiatry 1999; 38: 566–572.PubMedCrossRefGoogle Scholar
  35. 23.
    Wagner KD, Ambrosini P, Rynn M, et al. Efficacy for sertraline in the treatment of children and adolescents with major depressive disorder. JAMA 2003; 290: 1033–1041.PubMedCrossRefGoogle Scholar
  36. 24.
    Simeon JG, Dinicola VF, Ferguson HB, Copping W. Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up. Prog Neuropsychopharmacol Biol Psychiatry 1990; 14: 791–795.PubMedCrossRefGoogle Scholar
  37. 25.
    Keller MB, Ryan ND, Strober M, et al. Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2001; 40: 762–772.PubMedCrossRefGoogle Scholar
  38. 26.
    Wagner DD. Paroxetine treatment of mood and anxiety disorders in children and adolescents. Psychopharmacol Bull 2003; 37 Suppl 1: 167–175.Google Scholar
  39. 27.
    Braconnier A, Le Coent R, Cohen D. Paroxetine versus clomipramine in adolescents with severe major depression: a double-blind, randomized, multicenter trial. J Am Acad Child Adolesc Psychiatry 2003; 42: 22–29.PubMedCrossRefGoogle Scholar
  40. 28.
    U.S. Food and Drug Administration. FDA statement regarding the anti-depressant paxil for pediatric population, 2003. Please provide city and state of publication and name of publisher.Google Scholar
  41. 29.
    Emslie GJ, Rush AJ, Weinberg WA, et al. A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry 1997; 54: 1031–1037.PubMedCrossRefGoogle Scholar
  42. 30.
    Emslie GJ, Heiligenstein JH, Wagner KD, et al. Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2002; 41: 1205–1215.PubMedCrossRefGoogle Scholar
  43. 31.
    Hazell P, O’Connell D, Heathcote D, Robertson J, Henry D. Efficacy of tricyclic drugs in treating child and adolescent depression: a meta-analysis. Br Med J 1995; 310: 897–901.CrossRefGoogle Scholar
  44. 32.
    Hazell P, O’Connell D, Heathcote D, Henry D. Tricyclic drugs for depression in children and adolescents. Cochrane Database Syst Rev 2002; CD002317.Please provide volume # and page range.Google Scholar
  45. 33.
    Riddle MA, Geller B, Ryan N. Another sudden death in a child treated with desipramine. J Am Acad Child Adolesc Psychiatry 1993; 32: 792–797.PubMedCrossRefGoogle Scholar
  46. 34.
    Werry JS, Biederman J, Thisted R, Greenhill L, Ryan N. Resolved: cardiac arrhythmias make desipramine an unacceptable choice in children [Debate Forum]. J Am Acad Child Adolesc Psychiatry 1995; 34: 1239–1248.PubMedCrossRefGoogle Scholar
  47. 35.
    Biederman J, Thisted RA, Greenhill LL, Ryan ND. Estimation of the association between desipramine and the risk for sudden death in 5- to 14-year-old children. J Clin Psychiatry 1995; 56: 87–93.PubMedGoogle Scholar
  48. 36.
    Mezzacappa E, Steingard R, Kindlon D, Saul JP, Earls F. Tricyclic antidepressants and cardiac autonomic control in children and adolescents. J Am Acad Child Adolesc Psychiatry 1998; 37: 52–59.PubMedCrossRefGoogle Scholar
  49. 37.
    Leineweber K, Wangemann T, Giessler C, et al. Age-dependent changes of cardiac neuronal noradrenaline reuptake transporter (uptake1) in the human heart. J Am Coll Cardiol 2002; 40: 1459.PubMedCrossRefGoogle Scholar
  50. 38.
    Yeragani VK, Rao KA, Pohl R, Jampala VC, Balon R. Heart rate and QT variability in children with anxiety disorders: a preliminary report. Depress Anxiety 2001; 13: 72–77.PubMedCrossRefGoogle Scholar
  51. 39.
    Wilens TE, Biederman J, Baldessarini RJ, et al. Cardiovascular effects of therapeutic doses of tricyclic antidepressants in children and adolescents. J Am Acad Child Adolesc Psychiatry 1996; 35: 1491–1501.PubMedCrossRefGoogle Scholar
  52. 40.
    Biederman J, et al. Resolved: cardiac arrhythmias make desipramine an unacceptable choice in children. J Am Acad Child Adolesc Psychiatry 1995; 34: 1246–1248.CrossRefGoogle Scholar
  53. 41.
    Sasson Y, Zohar J, Chopra M, Lustig M, Iancu I, Hendler T. Epidemiology of obsessive-compulsive disorder: a world view. J Clin Psychiatry 1997; 58 Suppl 12: 7–10.Google Scholar
  54. 42.
    Graeff FG. Serotonergic systems. Psychiatr Clin North Am 1997; 20: 723–739.PubMedCrossRefGoogle Scholar
  55. 43.
    Nutt D. Management of patients with depression associated with anxiety symptoms. J Clin Psychiatry 1997; 58 Suppl 8: 11–16.Google Scholar
  56. 44.
    Geller DA, Wagner KD, Gallagher D, et al. Efficacy of paroxetine in pediatric OCD: results of a multicenter study. Presented at: Annual Meeting of the American Psychiatric Association, Philadelphia, Pa; 2002.Google Scholar
  57. 45.
    Rosenberg DR, Stewart CM, Fitzgerald KD, Tawile V, Carroll E. Paroxetine open-label treatment of pediatric outpatients with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 1999; 38: 1180–1185.PubMedCrossRefGoogle Scholar
  58. 46.
    Geller DA, Biederman J, Wagner KD, et al. Comorbid psychiatric illness and response to treatment, relapse rates, and behavioral adverse event incidence in pediatric OCD. Presented at: 41st Annual Meeting of the New Clinical Drug Evaluation Association, Phoenix, Ariz; 2001.Google Scholar
  59. 47.
    Emslie GJ, Wagner KD, Riddle M, et al. Efficacy and safety of paroxetine in juvenile OCD. Presented at: 153rd Annual Meeting of the American Psychiatric Association; Chicago, Ill; 2000.Google Scholar
  60. 48.
    Hollander E, Friedberg J, Wasserman S, Allen A, Birnbaum M, Koran LM. Venlafaxine in treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry 2003; 64: 546–550.PubMedCrossRefGoogle Scholar
  61. 49.
    Mancini C, Van Ameringen M, Farvolden P. Does SSRI augmentation with antidepressants that influence noradrenergic function resolve depression in obsessive-compulsive disorder? J Affect Disord 2002; 68: 59–65.PubMedCrossRefGoogle Scholar
  62. 50.
    Cornelius JR, Bukstein OG, Birmaher B, et al. Fluoxetine in adolescents with major depression and an alcohol use disorder: an open-label trial. Addict Behav 2001; 26: 735–739.PubMedCrossRefGoogle Scholar
  63. 51.
    Lifrak PD, Alterman AI, O’Brien CP, Volpicelli JR. Naltrexone for alcoholic adolescents. Am J Psychiatry 1997; 154: 439–440.PubMedGoogle Scholar
  64. 52.
    Wold M, Kaminer Y. Naltrexone for alcohol abuse. J Am Acad Child Adolesc Psychiatry 1997; 36: 6–7.PubMedCrossRefGoogle Scholar
  65. 53.
    Donnelly C. Pharmacologic treatment approaches for children and adolescents with post-traumatic stress disorder. Child Adolesc Psychiatr Clin N Am 2003; 12: 251–269.PubMedCrossRefGoogle Scholar
  66. 54.
    Seedat S, Stein DJ, Ziervogel C, et al. Comparison of response to a selective serotonin reuptake inhibitor in children, adolescents, and adults with posttraumatic stress disorder. J Child Adolesc Psychopharmacol 2002; 12: 37–46.PubMedCrossRefGoogle Scholar
  67. 55.
    Putnam FW, Hulsmann JE. Pharmacotherapy for survivors of childhood trauma. Semin Clin Neuropsychiatry 2002; 7: 129–136.PubMedCrossRefGoogle Scholar
  68. 56.
    Good C, Petersen C. SSRI and mirtazapine in PTSD. J Am Acad Child Adolesc Psychiatry 2001; 40: 263–264.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Domenic A. Ciraulo
  • Danielle M. Ciraulo
  • Glenn Saxe

There are no affiliations available

Personalised recommendations