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SSRI treatment is advocated for adolescent depression: called moderately effective, safe.

SEATTLE -- Selective serotonin reuptake inhibitors are appropriate for use in adolescents: They have modest efficacy and they are safe, Dr. Chistopher K. Varley said at the annual meeting of the Society for Adolescent Medicine.

In Texas, where officials and medical professionals have developed a strict protocol to facilitate depression treatment in adolescents, the practice is to use a selective serotonin reuptake inhibitor (SSRI) as first-line treatment in adolescents, noted Dr. Varley of the department of psychiatry at the University of Washington, Seattle.

The second line is to try another SSRI because some individuals who do not respond to one may respond to another one of the drugs.

Five years ago, no one could have recommended that an SSRI be prescribed to an adolescent because there were no data whatsoever.

Today, there are five, well-designed, controlled trials of SSRIs in adolescents, two of fluoxetine (Prozac, Sarafem), and one each of paroxetine (Paxil), citalopram (Celexa), and sertraline (Zoloft), he said.

The studies on fluoxetine and paroxetine have been published; the others have been presented at meetings.

Those studies do not show dramatic efficacy, but they do show that the drugs help adolescents with depression, Dr. Varley said.

In one of the fluoxetine studies in which a 20-mg dose was compared with placebo, 56% of patients responded, compared with 33% of the placebo group.

Not only is the separation of the groups not very great, but the flip side of the figures is that they show that more than 40% of those treated do not have any demonstrable improvement.

Even for the adolescents treated with fluoxetine who responded, the response was not necessarily remission but, rather, indicated some improvement on a depression scale, Dr. Varley commented.

That study is representative of the results reported for the other SSRI agents as well, he said at the meeting.

Still, use of an SSRI is preferable because other agents that are sometimes used to treat depression in adolescents have not specifically been studied in the adolescent population, he noted.

Those agents include fluvoxamine (Luvox), bupropion (Wellbutrin, Wellbutrin SR, Zyban), venlafaxine (Effexor, Effexor XR), and nefazodone (Serzone).

Two of those agents--fluvoxamine and venlafaxine--appear to be safe when they have been used in adolescents for other psychiatric conditions, but they have not been studied for efficacy in depression.

Tricyclic antidepressants have not been of any benefit in those trials in which the subjects were adolescents, he said at the conference.

The guidelines for treating adults suggest that the patient continue on SSRI medication for 4-6 months after their depression resolves, and that seems reasonable for adolescents also, Dr. Varley said.

Stopping medication can be tricky as there is a recognized withdrawal syndrome, he added. This withdrawal "mostly looks like flu--it is not a psychotic illness."

Patients being taken off an SSRI probably should be tapered, he said.


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Title Annotation:selective serotonin reuptake inhibitors; Behavioral Pediatrics
Author:Kirn, Timothy F.
Publication:Pediatric News
Geographic Code:1USA
Date:Aug 1, 2003
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