Fluoxetine in Children and Adolescents with Mood Disorders: A Chart Review of Efficacy and Adverse Effects

Abstract

The charts of 31 hospitalized children and adolescents (ages 9-18 years) with major mood disorders were retrospectively reviewed to examine the efficacy and side effects of treatment with fluoxetine. After treatment for a mean duration of 35 days, clinical improvement was seen in 74% of these patients; 54% had "much" to "very much" improvement as measured by the Clinical Global Impression scale (CGI). The most common adverse effects were hypomania-like symptoms (23%), irritability (19%), gastrointestinal upset (13%), and insomnia (13%). No EKG changes, blood pressure changes, anticholinergic symptoms, sedation, weight changes, or seizures were observed. None of the patients experienced an increase in suicidal or parasuicidal behavior. Discontinuation of the fluoxetine treatment occurred in 28% of cases, most commonly because of increasing irritability and hypomania-like symptoms. The hypomania-like effects included a constant sense of silliness, increased activity, poor sleep, increased energy, an increase in the stream of thoughts (racing thoughts), or socially intrusive or obnoxious behavor. Fluoxetine triggered symptoms suggestive of hypomania in all four of the depressive bipolar patients.

Use and impact of antidepressants in the school setting

“…In head-to-head comparisons, SSRIs have largely demonstrated superior efficacy in the remediation of depressive symptomatology in children and adolescents in comparison to TCAs (e.g., Colle, Belair, DiFeo, Weiss, & La Roche, 1994;Emslie, Rush, & Weinberg, 1997) while also demonstrating lower rates of discontinuation compared to the TCAs (Beasley, Bosomworth, & Wernicke, 1990). Furthermore, SSRIs present with a more preferential adverse event profile compared to TCAs (Jain, Birmaher, Garcia, Al-Shabbout, & Ryan, 1992). The specifics of SSRIs, including their utility and possible adverse reactions, are discussed later in this chapter.…”

Randomized controlled trials of antidepressants: clinically and scientifically irrelevant

“…With respect to SSRIs, the list includes delayed orgasm/ejaculation and anorgasmia [51][52][53], suicidal ideation [54], lethargic/apathetic frontal lobe syndrome [39,55], growth suppression [56], hostility, aggression, and violence [57,58], withdrawal reactions [27], and various forms of behavioral toxicity [59]. We conjectured that this obvious and glaring disparity (if one elects to notice it) probably could be understood, at least in part, on the basis of sponsorship and the resultant bias that sponsorship creates.…”

Major Depressive Disorder in Adolescence: A Brief Review of the Recent Treatment Literature

“…Retrospective chart reviews have also provided preliminary evidence on the effectiveness of SSRIs (specifically, fluoxetine, sertraline, and citalopram) in the treatment of adolescent MDD (42)(43)(44). Ambrosini and colleagues found that, in a sertraline treatment study of adolescent MDD, maximal clinical response, based on clinician and self-reported depressive symptoms, occurred after week 10, leading them to conclude that, to fully evaluate efficacy, acute-phase antidepressant therapy should extend to at least 10 weeks (37).…”