Side-effects of SSRIs disrupt multimodal treatment for pediatric OCD in a randomized-controlled trial

Abstract

Objective Activation Syndrome (AS) is a side-effect of antidepressants consisting of irritability, mania, self-harm, akathisia, and disinhibition. The current study was conducted to analyze how AS may hinder treatment outcome for multimodal treatment for children and adolescents with Obsessive-Compulsive Disorder. Methods Fifty-six children or adolescents were recruited at two treatment sites in a double-blind randomized-controlled trial where participants received Cognitive-Behavioral Therapy and were randomized to slow titration of sertraline, regular titration of sertraline or placebo. Results Using a recently developed measure of AS, results suggested that higher average levels of all five AS symptom clusters significantly interfered with treatment response and explained 18% of the variance in obsessive-compulsive symptoms during treatment. Interestingly, only session-to-session increases in irritability resulted in a session-to-session increase in obsessive-compulsive symptoms. The observed results were unchanged with the addition of SSRI dosage as a covariate. Conclusions Results provide empirical support for the proposed hypothesis that AS may hinder multimodal treatment outcome for pediatric OCD. These findings suggest that dosage changes due to AS do not explain why those with higher AS had worse multimodal outcome. Other possible mechanisms explaining this observed disruption are proposed, including how AS may interfere with Cognitive-Behavioral Therapy.

Curcumin Alters Neural Plasticity and Viability of Intact Hippocampal Circuits and Attenuates Behavioral Despair and COX-2 Expression in Chronically Stressed Rats

“…Also, there are issues of side effects including dry mouth, constipation and orthostatic hypotension, which have been frequently reported during the early phase of the treatment period. Therefore, there is a high demand for antidepressants with fewer side effects [ 5 ].…”

Antidepressant Tolerability in Pediatric Anxiety and Obsessive-Compulsive Disorders: A Bayesian Hierarchical Modeling Meta-analysis

“…Clinicians selecting antidepressant medications to treat pediatric patients need comparative tolerability data for specific AEs, particularly given that AEs limit titration to effective doses, slow the trajectory of improvement, and increase the likelihood of discontinuation. 25,26 Moreover, comparative tolerability data are critical for child and adolescent psychiatrists and other mental health clinicians who are ethically and medicolegally compelled to discuss medication side effects with patients and their parents. 27 The dearth of systematic evaluations of antidepressantrelated AEs in pediatric patients is understandable.…”

Antidepressant-like Effects of p-Coumaric Acid on LPS-induced Depressive and Inflammatory Changes in Rats

“…Interestingly, the inflammatory pathway has recently become an important topic in the development of novel antidepressants [ 5 ]. Therefore, prophylactic antidepressants with fewer side effects and more comprehensive effects should be developed [ 6 ].…”