Adolescent depression: A placebo-controlled fluoxetine treatment study and follow-up

Simeon, Jovan; DiNicola, Vincenzo F.; Ferguson, H. Bruce; Copping, W.

doi:10.1016/0278-5846(90)90050-q

Cited by 253 publications

(113 citation statements)

References 4 publications

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“…Overall, fluoxetine has had the largest number of studies with positive results, whereas paroxetine has had the largest number of studies with negative results. [34][35][36][37]39,42,43 However, methodologic differences may have played a role in these differing results. 23 The largest study, the Treatment for Adolescent Depression Study, involved subjects who were randomly assigned to receive placebo, cognitive behavioral therapy (CBT) alone, fluoxetine alone, or CBT with fluoxetine.…”

Section: Antidepressant Treatmentmentioning

confidence: 99%

“…This review has also been published elsewhere. 23 This GLAD-PC-initiated review identified 8 peer-reviewed articles in this area, including 4 trials with fluoxetine, [34][35][36][37] 1 with sertraline, 38 1 with citalopram, 38 1 with paroxetine, 39 and 1 with venlafaxine. 40 Older antidepressants (ie, monoamine oxidase inhibitors [MAOIs], tricyclic antidepressants) were not included in our review because the current controversy and the recent FDA review only involved newer classes of antidepressants and because of the known lack of efficacy (ie, tricyclic antidepressants) and clinical trials data (ie, MAOIs) for other classes of older antidepressants.…”

Section: Antidepressant Treatmentmentioning

confidence: 99%

“…Evidence from RCTs of antidepressants and CBT show that a sizable percentage of patients respond to nondirective supportive therapy and regular symptom monitoring. [34][35][36][37][38][39][40][62][63][64][65] However, if symptoms persist, treatment with antidepressants or psychotherapy should be offered. Active support and monitoring is also essential for cases in which depressed patients and/or their families/caregivers refuse other treatments.…”

Section: Guidelinesmentioning

confidence: 99%

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Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management

et al. 2007

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OBJECTIVES. To develop clinical practice guidelines to assist primary care clinicians in the management of adolescent depression. This second part of the guidelines addresses treatment and ongoing management of adolescent depression in the primary care setting.METHODS. Using a combination of evidence-and consensus-based methodologies, guidelines were developed in 5 phases as informed by (1) current scientific evidence (published and unpublished), (2) a series of focus groups, (3) a formal survey, (4) an expert consensus workshop, and (5) revision and iteration among members of the steering committee.RESULTS. These guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in primary care, including (1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and its evidence base are summarized.CONCLUSIONS. These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist primary care clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of youth with depression in primary care is needed, including the usability, feasibility, and sustainability of guidelines and determination of the extent to which the guidelines actually improve outcomes of youth with depression. that up to 9% of teenagers meet criteria for depression at any one time, with as many as 1 in 5 teens having a history of depression at some point during adolescence. [1][2][3][4][5] In primary care (PC) settings, point prevalence rates are likely higher, with rates up to 28%. 6-10 Taken together, epidemiologic and PCspecific studies have suggested that despite relatively high rates, major depressive disorder (MDD) in youth is underidentified and undertreated in PC settings. 11 Because of barriers to adolescents receiving specialty mental health services, only a small percentage of depressed adolescents are treated by mental health professionals. 12 As a result, PC settings have become the de facto mental health clinics for this population, although most PC clinicians feel inadequately trained, supported, or reimbursed for the management of this disorder. [13][14][15][16][17][18] Although MDD management guidelines have been developed for specialty care settings (eg, see the American Academy of Child and Adolescent Psychiatry [AACAP] practice parameters 19 ) or for related problems such as suicidal ideation or attempts, 2...

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Section: Antidepressant Treatmentmentioning

confidence: 99%

Section: Antidepressant Treatmentmentioning

confidence: 99%

Section: Guidelinesmentioning

confidence: 99%

See 1 more Smart Citation

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management

et al. 2007

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“…Several double-blind, placebo-controlled trials have studied the efficacy of SSRIs in adolescent depression (5)(6)(7). The largest study involved 275 patients and demonstrated significantly higher remission rates for subjects in the paroxetine group, compared with imipramine or placebo (7).…”

mentioning

confidence: 99%

Impact of Antidepressant Side Effects on Adolescent Quality of Life

2003

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Objective: This study examines the relative impact of antidepressant side effects on adolescents with a history of major depression. Methods:We used Q-sort methodology to capture the opinions of adolescents with a history of depression (n = 22), adults with a history of depression (n = 20), healthy adolescents (n = 20), and clinicians (n = 18) on the impact of 40 common antidepressant side effects. We asked subjects to force rank the side effects, judging each side effect on its relative impact on their daily lives. We also examined the impact of these side effects on health status and medication compliance. Primary analyses compared adolescents with depression with the other groups on their mean rankings for each of the 40 side effects. Secondary analyses included paired comparisons for ratings on health status and compliance.Results: Although all groups ranked syncope and vomiting among the worst 5 side effects, significant differences were found between the groups on other side effects, such as anxiety, sleepiness, and hair loss. Based on the side effect with the most negative impact, adolescents with depression judged their own compliance (mean = 22%) to be higher than predicted by clinicians (mean = 11%). There were no significant differences between the groups on the mean rating of health status. Conclusions:Adolescents with depression, adults with depression, healthy adolescents, and clinicians agreed on the negative impact of 2 side effects: vomiting and syncope. Q-sort methodology provides valuable insight into the similarities and differences in opinion regarding the potential impact of side effects in patient groups. (Can J Psychiatry 2003;48:727-734) Information on funding and support and author affiliations appears at the end of the article. Clinical Implications· Clinicians need to recognize their limitations in judging the impact of side effects. · Impaired functioning is a major concern for adolescents experiencing side effects from medications. · Q-sort methodology may be an appropriate method for measuring the impact of side effects in other clinical populations. Limitations· The sample size was small. · Clinicians were asked to judge the impact of potential side effects on adolescent patients in general, rather than judging the impact for a specific patient under their care. · Subjects were asked to judge the impact of side effects in a hypothetical situation.

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“…There are currently two controlled published SSRI studies (44,45) involving fluoxetine and paroxetine that suggest a significant improvement in MDD with these agents. Other studies involving fluoxetine (46) and venlafaxine (47), or most recently paroxetine (48), have not shown such significant results. Currently, there are ongoing multicentre and multinational studies, with further reports on other putatively effective agents pending.…”

Section: Antidepressant Agentsmentioning

confidence: 96%