Fluoxetine in tricyclic refractory depression in adolescents

Ghaziuddin, Neera; Naylor, Michael W.; King, Cheryl A.

doi:10.1002/depr.3050020602

Cited by 22 publications

(6 citation statements)

References 22 publications

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“…Controlled and uncontrolled studies have generally shown that tricyclic antidepressants (TCAs) are not more effective than placebo in the treatment of childhood and adolescent depression (Kramer and Feiguine 1981, Strober et al 1990, Boulos et al 1991, Geller et al 1990). The possible effectiveness of selective serotonin uptake inhibitors (SSRIs) is suggested in open trials (Boulos et al 1992, Jain et al 1992, Ghaziuddin et al 1995. The only published data on a double-blind placebo-controlled study of fluoxetine showed a moderate improvement (not reaching clinical significance) among 40 adolescents (aged 13-18 years) both at 8 weeks and at 24-month follow-up (Simeon et al 1990).…”

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confidence: 97%

Electroconvulsive Treatment in Adolescents with Pharmacotherapy–Refractory Depression

Ghaziuddin¹,

King²,

Naylor³

et al. 1996

Journal of Child and Adolescent Psychopharmacology

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The effectiveness and safety of ECT in pharmacotherapy-refractory depression was examined in 11 hospitalized adolescents (ages 16.3 +/- 1.7 years, 10 females) with a primary DSM-III-R diagnosis of mood disorder, which had failed to respond to three or more adequate trials of antidepressant pharmacotherapy. After a thorough diagnostic evaluation, patients received a course of ECT involving 11.2 +/- 2.0 (range 8-15) administrations. ECT was commenced with bilateral treatment in 2 adolescents and nondominant right electrode placement in 9 patients; 5 of the 9 patients were subsequently changed to bilateral treatment. All 11 patients improved to a clinically significant degree. Significant improvements were noted in scores on the Children Depression Rating Scale-Revised (CDSR-R) and the Global Assessment of Functioning Scale (GAF) (p < 0.05). Euthymia, defined as CDRS-R score < or = 40, was achieved by 64% (7/11) of patients. The Mini-Mental State Examination showed no significant decline in cognitive functioning. Neuropsychological testing completed in 5 subjects both before ECT and 1-5 days after the last treatment, indicated a significant decline in attention, concentration, and long-term memory search. Minor side effects, experienced within the first 12 hours of treatment, were headache (80% of patients) and nausea/vomiting (64%). The potentially serious complication of tardive seizure (after full recovery of consciousness) occurred in 1 adolescent. Prolonged seizures (> 2.5 minutes) were noted in 7 of the 11 patients (9.6% of the 135 ECT administrations). Pending further research on ECT in youth, it is recommended that ECT should only be administered to youth in hospital settings, that all regularly administered psychotropic medications (including antidepressants) be discontinued before ECT and restarted after the final administration of ECT, and that physicians be aware that 12 treatments are usually sufficient, but that 15 treatments may occasionally be necessary for treating depressed adolescents. With the understanding that scientific evaluation of ECT in youth is lacking, it appears that ECT can be an effective and relatively safe treatment for depressed adolescents who have failed to respond to antidepressant pharmacotherapy.

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confidence: 97%

Electroconvulsive Treatment in Adolescents with Pharmacotherapy–Refractory Depression

Ghaziuddin¹,

King²,

Naylor³

et al. 1996

Journal of Child and Adolescent Psychopharmacology

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“…However, more recently attention has turned to the SSRIs, with their better side effect profile, and the fact that the noradrenergic system may not be fully developed until early adulthood, which may explain, in part, the differential response in adults and children (Goldman-Rakic & Brown, 1982). Open studies of SSRIs have shown them to be well tolerated and effective (Boulos et al, 1992 ;Ghaziuddin, Naylor, & King 1995 ;Waslick et al, 1999), in addition to a randomised controlled double blind trial (Emslie et al, 1997). A large (N l 432) multicentre, randomised clinical trial comparing the effectiveness of Fluoxetine, CBT, combination therapy and placebo is currently underway (Treatment for Adolescents with Depression Study, NIMH).…”

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confidence: 97%

Prescribing Practices of Child Psychiatrists in the UK

McNicholas

2001

Child Adolesc Ment Health

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This study reports on a nation-wide survey of a randomly selected group of child psychiatrists and examines their prescribing practices for a wide range of psychotropic medication in a wide range of disorders. Despite 98 % of the sample valuing medication as a treatment modality, one third of clinicians prescribed rarely or not at all. More than three-quarters felt insufficiently competent in this area, a finding which was significantly associated with less frequent or no prescribing. Half of the sample believed that if they were better informed they would prescribe more and 91 % requested regular psychopharmacology seminars.

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“…[137][138][139][140][141] For this reason, it has been the most extensively studied SSRI in the depressed young (table IV). There are 5 reports that did not employ a placebocontrolled design, [142][143][144][145][146] and also 2 double-blind studies that compared the antidepressant effects of fluoxetine with placebo. [147,148] In 1 of these studies fluoxetine was found to be superior to placebo.…”

Section: Fluoxetinementioning

confidence: 97%

“…[147] Effectiveness As can be seen in table IV, all 5 nonblind reports with fluoxetine described clinically significant reductions in symptomatology for most patients. [142][143][144][145][146] The first double-blind study comparing fluoxetine to placebo in depressed adolescents failed to show a significant drug effect. [147] However, the small sample size and/or a high rate of placebo response may account for this finding.…”

Section: Fluoxetinementioning

confidence: 98%

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Pharmacological Treatment of Depression in Children and Adolescents

1999

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Major depression is a common disorder during childhood and adolescence. Over the past decade, many new antidepressants have been marketed in the US. In adults, these newer agents have been shown to be as effective as the prototypic tricyclic antidepressants (TCAs). Further, when compared with the TCAs these medications are better tolerated and are safer in overdose. Although TCAs are effective in the treatment of depressed adults, controlled clinical trials have not demonstrated their efficacy in either children or adolescents. In addition, concerns about the safety of TCAs and the monoamine oxidase inhibitors has left disappointingly few pharmacological treatment options available for depressed children and adolescents. For this reason, clinicians have begun to prescribe the newer agents for this population, despite the fact that relatively little is known about their disposition, safety or effectiveness in the young. Investigators have begun to examine whether the use of newer antidepressant medications such as fluoxetine, sertraline, paroxetine, fluvoxamine, nefazodone, and venlafaxine is truly indicated for children and adolescents with major depression. Pharmacokinetic studies of sertraline, paroxetine and nefazodone have been performed in depressed youths. The results of these studies have provided data for rational administration strategies for these agents. They have also provided evidence that these agents may be well tolerated in children and adolescents. Further evidence that these agents are often well tolerated when prescribed to depressed youths has been obtained from both open-label and double-blind studies. Published studies have generally shown that open-label treatment with these newer agents often leads to symptom amelioration in paediatric patients with major depression. Since high rates of placebo response are often seen in depressed children and adolescents, results from these studies cannot be interpreted to suggest that these medications have true antidepressant efficacy in this population. At present, the results of only two such studies have been published. The results of one of these trials are difficult to interpret because of methodological considerations. The other study reported that treatment with fluoxetine was superior to placebo. This paper critically reviews what has been published about the pharmacological treatment of depressed paediatric patients and provides some guidance to the use of antidepressants in this patient population, paying particular attention to what is known about the newer antidepressants as well as considering directions for future research.

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Fluoxetine in tricyclic refractory depression in adolescents

Cited by 22 publications

References 22 publications

Electroconvulsive Treatment in Adolescents with Pharmacotherapy–Refractory Depression

Electroconvulsive Treatment in Adolescents with Pharmacotherapy–Refractory Depression

Prescribing Practices of Child Psychiatrists in the UK

Pharmacological Treatment of Depression in Children and Adolescents

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