Fluoxetine in the Management of Major Depressive Disorder in Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Fluoxetine is a serotonin-specific reuptake inhibitor antidepressant and is the only approved pharmacological treatment for major depressive disorder (MDD) in children and adolescent. Methods: We searched the published randomized controlled-trials to review fluoxetine efficacy and tolerability using the databases PubMed, EudraCT, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for fluoxetine role in managing MDD in children and adolescents. A meta-analysis was conducted using the identified 7 clinical trials to assess efficacy using the outcomes: Children's Depression Rating Scale–Revised (CDRS-R), Clinical Global Impressions–Severity of Illness (CGI-S) and Clinical Global Impressions–Improvement (CGI-I) response rate. The risk of discontinuation due to adverse effects and common side effects were examined. Results: The mean difference in change from baseline for CDRS-R was −2.72 (95% confidence interval [CI], −3.96, −1.48) favoring fluoxetine treatment ( P < .001). Similarly, mean difference for CGI-S was −0.21 (95% CI, −0.36, −0.06). The risk ratio (RR) of discontinuing due to adverse events was 0.98 (95% CI, 0.54, 1.83), with RR for headache side effects 1.34 (95% CI, 1.03, 1.74) and rash 2.6 (95% CI, 1.32, 5.14). Conclusion: Fluoxetine demonstrates significant improvements in symptom intensity control in young patients suffering from MDD and is considered well tolerated with similar rates of trials discontinuation; however, fluoxetine was associated with a higher risk of headache and rash side effects. These findings will guide psychiatrists and pharmacists in their clinical role for supporting the care of young mental health patients.

The anti-depression function of selective serotonin reuptake inhibitor

“…According to studies [5], fluoxetine can not only improve the mood of depressed adolescents by regulating the function of brain regions associated with adolescent depression, such as the amygdaloid-hippocampus and the dorsal anterior cingulate cortex, but also regulate the level of chemokines related to the onset of depression. Fluoxetine has no anticholinergic impact, no effect on epinephrine and, dopamine and histamine receptors.…”

Research Progress on the Pharmacodynamic Mechanisms of Sini Powder against Depression from the Perspective of the Central Nervous System

“…Although current anti-depression treatments can be effective, effective action requires up to 6 weeks with multiple therapeutic agents, while side effects are observed [6]. Selective serotonin reuptake inhibitors (SSRIs), a typical type of anti-depression drug via restoring neuroplasticity, may lead to adverse effects, such as headache, insomnia, fatigue, and somnolence, which eventually increase suicide rates in adolescents with depression in the early stages of treatment [7][8][9][10]. Hence, novel therapeutic options are needed for the safe and effective treatment of depression.…”

Metabolomic identification of biochemical changes induced by fluoxetine in an insulinoma cell line (MIN6)

“…Depression is a prevalent complex psychiatric disorder characterized by low mood and a loss of pleasure ( 1 2 3 ). This disorder is a major cause of disability in children and adolescents and can result in difficulties in social functioning and suicide ( 2 ). To alleviate this problem, patients may be prescribed antidepressants.…”