Pharmacotherapy of child and adolescent depression: a review

Abstract

Child and adolescent depression (CAD) is a frequent disorder, which may have a recurring and chronic course and, as a result may cause significant morbidity and mortality. Currently, antidepressant medications, cognitive behavioral therapy (CBT), and interpersonal therapy (IPT) are the treatment options whose efficacies have been proven in the treatment of CAD. Here, pharmacotherapy of CAD will be reviewed and priority will be given to prospective, methodologically more reliable and comparable studies, published in the past ten years. Studies on selective serotonin reuptake inhibitors and other medications, along with those comparing or combining medications to behavioral treatments will be summarized. Furthermore, suggestions regarding the treatment of CAD with and without comorbidities and possible side effects will be evaluated.

Keywords

• -

Çocuk ve ergenlerde depresyonun ilaçla tedavisi: Bir gözden geçirme

Öz

Çocuk ve ergenlik dönemi depresyonu (ÇED) sık, tekrarlayıcı ve kronik bir seyir izleyebilen bir bozukluk olup ciddi morbidite ve mortalite ile sonuçlanabilmektedir. Günümüzde ÇED tedavisinde antidepresan ilaçlar, bilişsel davranışçı terapi (BDT) ve kişiler arası terapi (KAT) etkinliği gösterilmiş tedavi seçenekleridir. Bu gözden geçirmede ÇED’in ilaçla tedavisi gözden geçirilecek ve son on yılda basılmış, ileri dönük ve yöntemsel olarak daha güvenilir ve kıyaslanabilir çalışmalara öncelik verilecektir. Seçici serotonin gerialım engelleyicileri ve diğer antidepresanlarla yapılan çalışmaların yanı sıra, ilaç tedavilerinin davranışçı tedaviler ile karşılaştırıldığı ya da birlikte kullanıldığı çalışmalar özetlenecektir. Ayrıca ÇED’in tek başına ve ekhastalıklarla birlikte bulunduğu durumlardaki tedavisiyle ilgili öneriler sunulacak ve ilaç tedavisi ile görülebilen yan etkiler değerlendirilecektir.

Anahtar Kelimeler

• Depresyon, çocuk, ergen, ilaçla tedavi, bilişsel davranışçı terapi

References

1. Lewinsohn P, Rohde P, Seeley J. Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications. Clin Psychol Rev. 1998;18:765-94.
2. Birmaher B, Brent D, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with depressive disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:1503-26.
3. Birmaher B, Arbelaez C, Brent D. Course and outcome of child and adolescent major depressive disorder. Child Adolesc Psychiatr Clin N Am. 2002;11:619-37.
4. Costello E, Pine D, Hammen C, March J, Plotsky P, Weissman M, et al. Development and natural history of mood disorders. Biol Psychiatry. 2002;52:529-42.
5. Emslie G, Rush A, Weinberg W, Kowatch R, Hughes C, Carmody T, et al. A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry. 1997;54:1031-7.
6. Emslie G, Heiligenstein J, Wagner K, Hoog S, Ernest D, Brown E, 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;41:1205-15.
7. March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004;292:807-20.
8. Kennard B, Silva S, Vitiello B, Curry J, Kratochvil C, Simons A, et al. Remission and residual symptoms after short-term treatment in the Treatment of Adolescents with Depression Study (TADS). J Am Acad Child Adolesc Psychiatry. 2006;45:1404-11.

9. Curry J, Rohde P, Simons A, Silva S, Vitiello B, Kratochvil C, et al. Predictors and moderators of acute outcome in the Treatment for Adolescents with Depression Study (TADS). J Am Acad Child Adolesc Psychiatry. 2006;45:1427-39.
10. Kennard B, Silva S, Tonev S, Rohde P, Hughes J, Vitiello B, et al. Remission and recovery in the Treatment for Adolescents with Depression Study (TADS): acute and long-term outcomes. J Am Acad Child Adolesc Psychiatry. 2009;48:186-95.
11. Goodyer I, Dubicka B, Wilkinson P, Kelvin R, Roberts C, Byford S, et al. A randomised controlled trial of cognitive behaviour therapy in adolescents with major depression treated by selective serotonin reuptake inhibitors. The ADAPT trial. Health Technol Assess. 2008;12:iii:iv-ix-60.
12. Berard R, Fong R, Carpenter D, Thomason C, Wilkinson C. An international, multicenter, placebo-controlled trial of paroxetine in adolescents with major depressive disorder. J Child Adolesc Psychopharmacol. 2006;16:59-75.
13. Emslie G, Wagner K, Kutcher S, Krulewicz S, Fong R, Carpenter D, et al. Paroxetine Treatment in Children and Adolescents With Major Depressive Disorder: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2006;45:709-19.
14. Keller M, Ryan N, Strober M, Klein R, Kutcher S, Birmaher B, et al. Efficacy of Paroxetine in the Treatment of Adolescent Major Depression: A Randomized, Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2001;40:762-72.
15. Wagner K, Jonas J, Findling R, Ventura D, Saikali K. A Double- Blind, Randomized, Placebo-Controlled Trial of Escitalopram in the Treatment of Pediatric Depression. J Am Acad Child Adolesc Psychiatry. 2006;45:280-8.
16. Emslie G, Ventura D, Korotzer A, Tourkodimitris S. Escitalopram in the Treatment of Adolescent Depression: A Randomized Placebo- Controlled Multisite Trial. J Am Acad Child Adolesc Psychiatry. 2009;48:721-9.
17. Wagner K, Ambrosini P, Rynn M, Wohlberg C, Yang R, Greenbaum M, et al. Efficacy of Sertraline in the Treatment of Children and Adolescents With Major Depressive Disorder: Two Randomized Controlled Trials. JAMA. 2003;290:1033-41.
18. Wagner K, Robb A, Findling R, Jin J, Gutierrez M, Heydorn W. A Randomized, Placebo-Controlled Trial of Citalopram for the Treatment of Major Depression in Children and Adolescents. Am J Psychiatry. 2004;161:1079-83.
19. Von Knorring A, Olsson G, Thomsen P, Lemming O, Hultén A. A randomized, double-blind, placebo-controlled study of citalopram in adolescents with major depressive disorder. J Clin Psychopharmacol. 2006 26:311-5.
20. Hazell P, O’Connell D, Heathcote D, Robertson J, Henry D. Efficacy of tricyclic drugs in treating children and adolescent depression: a meta-analysis. BMJ. 1995;310:897-901.
21. Tsapakis E, FSoldani, Tondo L, Baldessarini R. Efficacy of antidepressants in juvenile depression: meta-analysis. Br J Psychiatry. 2008;193:10-7.
22. Mandoki M, Tapia M, Tapia M, Sumner G, Parker J. Venlafaxine in the treatment of children and adolescents with major depression. Psychopharmacol Bull. 1997;33:149-54.
23. Emslie G, Findling R, Yeung P, Kunz N, Li Y. Venlafaxine ER for the Treatment of Pediatric Subjects With Depression: Results of Two Placebo-Controlled Trials. J Am Acad Child Adolesc Psychiatry. 2007;46:479-88.
24. Cheung A, Emslie G, Mayes T. Review of the efficacy and safety of antidepressants in youth depression. J Child Psychol Psychiatry. 2005;46:735-54.
25. Rynn M, Findling R, Emslie G, Marcus R, Fernandes L, D’Amico M, et al., editors. Efficacy and safety of nefazodone in adolescents with MDD (Abstract NR57). 155th Annual Meeting of the American Psychiatric Association; 2002; Philadelphia: American Psychiatric Press.
26. Review and Evaluation of Clinical Data-NDA: 20-152 [İnternet veritabanı]. 2002. Available from: http://www.fda.gov/downloads/ Drugs/DevelopmentApprovalProcess/DevelopmentResources/ UCM164073.pdf.
27. Avci A, Diler R, Kibar M, Toros F. Comparison of moclobemide and placebo in young adolescents with major depressive disorder. Ann Med Sciences. 1999;8:31-40.
28. Bauer M, Adli M, Bschor T, Pilhatsch M, Pfennig A, Sasse J, et al. Lithium’s emerging role in the treatment of refractory makor depressive episodes: augmentation of antidepressants. Neuropsychobiology. 2010;62:36-42.
29. Cooper-Kazaz R, Apter J, Cohen R, Karagichev L, Muhammed- Moussa S, Grupper D, et al. Combined treatment with sertraline and liothyronine in major depression: a randomized, double-blind, placebo-controlled trial. Arch Gen Psychiatry. 2007;64:679-88.
30. Komossa K, Depping A, Gaudchau A, Kissling W, Leucht S. Second-generation antipsychotics for major depressive disorder and dysthymia. Cochrane Database Syst Rev. 2010;12(CD008121).
31. Hughes C, Emslie G, Crimson L, Posner K, Birmaher B, Ryan N, et al. Texas Children’s Medication Algorithm Project: Update From Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:667-86.
32. Goodyer I, Dubicka B, Wilkinson P, Kelvin R, Roberts C, Byford S, et al. Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behavior therapy in adolescents with major depression: randomised controlled trial. BMJ. 2007;335:142.
33. Renaud J, Brent D, Baugher M, Birmaher B, Kolko D, Bridge J. Rapid response to psychosocial treatment for adolescent depression: a two-year follow-up. J Am Acad Child Adolesc Psychiatry. 1998;37:1184-90.
34. Mufson L, Weissman M, Moreau D, Garfinkel R. Efficacy of interpersonal psychotherapy for depressed adolescents. Arch Gen Psychiatry. 1999;56:573-9.
35. Melvin G, Tonge B, King N, Heyne D, Gordon M, Klimkeit E. A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression. J Am Acad Child Adolesc Psychiatry. 2006;45:1151-61.
36. Emslie G, Rush A, Weinberg W, Kowatch R, Carmody T, Mayes T. Fluoxetine in child and adolescent depression: acute and maintenance treatment. Depress Anxiety. 1998;7:32-9.
37. Quitkin F, McGrath P, Stewart J, Deliyannides D, Taylor B, Davies C, et al. Remission rates with 3 consecutive antidepressant trials: effectiveness for depressed outpatients. J Clin Psychiatry. 2005;66:670-6.
38. Brent D, Emslie G, Clarke G, Wagner K, Asarnow J, Keller M, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA. 2008;299:901-13.
39. Asarnow J, Emslie G, Clarke G, Wagner K, Spirito A, Vitiello B, et al. Treatment of selective serotonin reuptake inhibitor- resistant depression in adolescents: predictors and moderators of treatment response. J Am Acad Child Adolesc Psychiatry. 2009;48:330-9.
40. Emslie G, Mayes T, Porta G, Vitiello B, Clarke G, Wagner K, et al. Treatment of Resistant Depression in Adolescents (TORDIA): week 24 outcomes. Am J Psychiatry. 2010;167:782-91.
41. Vitiello B, Emslie G, Clarke G, Wagner K, Asarnow J, Keller M, et al. Long-term outcome of adolescent depression initially resistant to selective serotonin reuptake inhibitor treatment: a follow-up study of the TORDIA sample. J Clin Psychiatry. 2010;[Epub ahead of print].
42. Brent D, Birmaher B. Treatment-Resistant Depression in Adolescents: Recognition and Management. Child Adolesc Psychiatric Clin N Am. 2006;15:1015-34.
43. Pliszka S, Crismon M, Hughes C, Corners C, Emslie G, Jensen P, et al. The Texas Children’s Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention- deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2006;45:642-57.
44. Birmaher B, Axelson D, Monk K, Kalas C, Clark D, Ehmann M, et al. Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2003;42:415-23.
45. Rynn M, Siqueland L, Rickels K. Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder. Am J Psychiatry. 2001;158:2008-14.
46. Walkup J, Labellarte M, Riddle M, Pine D, Greenhill L, Fairbanks J, et al. Treatment of pediatric anxiety disorders: an open-label extension of the research units on pediatric psychopharmacology anxiety study. J Child Adolesc Psychopharmacol. 2002;12:175-88.
47. Wagner K, Berard R, Stein M, Wetherhold E, Carpenter D, Perera P, et al. A multicenter, randomized, double-blind, placebo- controlled trial of paroxetine in children and adolescents with social anxiety disorder. Arch Gen Psychiatry. 2004;61:1153-62.
48. Riddle M, Reeve E, Yaryura-Tobias J, Yang H, Claghorn J, Gaffney G, et al. Fluvoxamine for children and adolescents with obsessive- compulsive disorder: a randomized, controlled, multicenter trial. J Am Acad Child Adolesc Psychiatry. 2001;40:222-9.
49. Riddle M, Scahill L, King R, Hardin M, Anderson G, Ort S, et al. Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 1992;31:1062-9.
50. March J, Biederman J, Wolkow R, Safferman A, Mardekian J, Cook E, et al. Sertraline in children and adolescents with obsessive- compulsive disorder: a multicenter randomized controlled trial. JAMA. 1998;280:1752-6.
51. Schur S, Sikich L, Findling R, Malone R, Crismon M, Derivan A, et al. Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part I: a review. J Am Acad Child Adolesc Psychiatry. 2003;42:132-44.
52. Akiskal H, Maser J, Zeller P, Endicott J, Coryell W, Keller M, et al. Switching from ‘unipolar’ to bipolar II. An 11-year prospective study of clinical and temperamental predictors in 559 patients. Arch Gen Psychiatry. 1995;52:114-23.
53. Boylan K, Romero S, Birmaher B. Psychopharmacologic treatment of pediatric major depressive disorder. Psychopharmacology. 2007;191:27-38.
54. Hammad T, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry. 2006;63:332-9.
55. Bridge J, Iyengar S, Salary C, Barbe R, Birmaher B, Pincus H, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta- analysis of randomized clinical trials. JAMA. 2007;297:1683-96.
56. Olfson M, Shaffer D, Marcus S, Greenberg T. Relationship between antidepressant medication treatment and suicide in adolescents. Arch Gen Psychiatry. 2003;60:978-82.
57. Gibbons R, Brown C, Hur K, Marcus S, Bhaumik D, Erkens J, et al. Early evidence on the effect of regulators’ suicidality warning on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry. 2007;164:1356-63.