Switching to Another SSRI or to Venlafaxine With or Without Cognitive Behavioral Therapy for Adolescents With SSRI-Resistant Depression

Brent, David A.; Emslie, Graham J.; Clarke, Greg; Wagner, Karen Dineen; Asarnow, Joan Rosenbaum; Keller, Marty; Vitiello, Benedetto; Ritz, Louise; Iyengar, Satish; Abebe, Kaleab Z.; Birmaher, Boris; Ryan, Neal D.; Kennard, Betsy D.; Hughes, Carroll W.; DeBar, Lynn; McCracken, James T.; Strober, Michael; Suddath, Robert; Spirito, Anthony; Leonard, Henrietta L.; Melhem, Nadine M.; Porta, Giovanna; Onorato, Matthew T.; Zelazny, Jamie

doi:10.1001/jama.299.8.901

Cited by 617 publications

(486 citation statements)

References 71 publications

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“…Fischer (2013) ha iniciado un ECA para evaluar la efi cacia de este programa, que prevé acabar de recoger datos a fi nales del 2014. El Treatment of SSRI-Resistant Adolescent Depression (TORDIA; Brent et al, 2008) es el único estudio que evalúa de forma separada las autolesiones no suicidas de aquellas con intencionalidad suicida. Incluye adolescentes de 12 a 18 años con diagnóstico de trastorno depresivo mayor y que no tienen respuesta a un inhibidor selectivo de la recaptación de la serotonina (ISRS).…”

Section: Terapias Cognitivo-conductualesunclassified

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Autolesiones no suicidas en adolescentes: revisión de los tratamientos psicológicos

Mollà¹,

Vila²,

Treen³

et al. 2015

RPPC

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Resumen: Las autolesiones en adolescentes han adquirido mayor relevancia en los últimos años, por el aumento de prevalencia, el mayor riesgo de realizar una tentativa autolítica y de desarrollar un trastorno límite de la personalidad o un trastorno depresivo mayor. Nuestro objetivo es revisar la bibliografía referente a tratamientos psicológicos para las autolesiones no suicidas (non-suicidal self-injury; NSSI). Se incluyen estudios que evalúan una intervención psicoterapéutica para el tratamiento de las autolesiones. Los resultados indican que ningún tratamiento para las autolesiones ha demostrado sufi ciente evidencia en adolescentes. La terapia basada en mentalización (MBT-A) ha demostrado efi cacia en un estudio y la terapia dialéctica-conductual (DBT-A) ha demostrado efectividad. La variedad y heterogeneidad de resultados difi culta extraer conclusiones más específi cas, como cuáles son los componentes activos efi caces. Valoramos la necesidad de estandarizar criterios e instrumentos en el campo del tratamiento de las autolesiones para mejorar la validez y utilidad de los resultados. Palabras clave:Non suicidal self-injury; psychological treatment; psychotherapy; self-injury. Non-suicidal self-harm in adolescents: A review of psychological treatmentsAbstract: Self-harm in teenagers has become more important in recent years, given its increased prevalence and the greater risk involved of making a suicidal attempt and developing a borderline personality disorder or a major depressive disorder. We aim to review the literature as to psychological treatments for non-suicidal self-injury (NSSI). Studies assessing a psychotherapeutic intervention for self-harm have been included. The results indicate that no treatment for self-harm has demonstrated enough evidence in adolescents. Mentalization based therapy (MBT-A) has shown effi cacy in one study and the dialectical behavior therapy (DBT-A) has shown effi cacy. However, the variety and heterogeneity of results make it diffi cult to draw more specifi c conclusions, such as regards the effective active components. Criteria and instruments in the fi eld of the treatment of NSSI need to be standardized in order to improve the validity and clinical utility of results.

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Section: Terapias Cognitivo-conductualesunclassified

“…El entrenamiento en solución de problemas y en habilidades sociales fueron los componentes más efi caces en los datos analizados (Kennard, 2009). A pesar de esto, no se encontraron diferencias en la ratio de episodios de NSSI (Brent et al, 2008).…”

Section: Terapias Cognitivo-conductualesunclassified

Autolesiones no suicidas en adolescentes: revisión de los tratamientos psicológicos

Mollà¹,

Vila²,

Treen³

et al. 2015

RPPC

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“…32 However, of patients who do not respond to fluoxetine, 50% will respond to another SSRI antidepressant. 33 In the UK, sertraline and citalopram are regarded as second-line SSRIs for child and adolescent depression 11 (see Table 2), and this has some research support. 34 Citalopram is associated with QT prolongation and so individuals known to have cardiac abnormalities, or at risk of these, should have an ECG carried out prior to using this drug.…”

Section: Pharmacotherapymentioning

confidence: 99%

“…A third-line drug would be venlafaxine which may be beneficial, 33 but the side effects result in a high level of non-adherence. The antidepressants frequently used in the USA are also included in Table 2 given the mobility of young people from the USA to Europe.…”

Section: Pharmacotherapymentioning

confidence: 99%

Management of depression in children and adolescents

Gledhill¹,

Hodes²

2015

Prog Neurol Psychiatry

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“…5 In the Treatment of Adolescent Depression Study, 6 the rate of suicidal events was lower in the combination of antidepressant and CBT than in medication alone; however, in other clinical trials of more severely or chronically depressed youth, no protective effect was found for combination treatment. 6,7 No relation has been established among dosage, adherence pattern, medication type, and risk for events, and while some promising pharmacogenetic findings have been reported, there is currently no clinical applicability of these findings.Several hypotheses, all unproven, have been advanced to explain the increased rate of suicidal events in antidepressant-treated patients, compared with those on placebo. These have included induction of akathisia, disinhibition, increasing energy of the patient to the point where he or she can actually make an attempt, induction of mania or a mixed state, or withdrawal from medication as a result of nonadherence, with induction of dysphoria and suicidality.…”

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confidence: 99%

Selective Serotonin Reuptake Inhibitors and Suicidality: A Guide for the Perplexed

Brent

2009

Can J Psychiatry

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T he rate of suicidal adverse events is elevated around 2-fold in drugs, relative to placeboes, in clinical trials of antidepressants in children, adolescents, and young adults. 1,2 Since the FDA's black box warning in [2003][2004], there has been a decline in the prescription rate of antidepressants, with no compensatory increase in referrals for psychotherapy in the United States. 3 Families, patients, and clinicians are uncertain about how to balance the benefits and risks of antidepressants. In this brief review, the clinical significance of suicidal events is discussed along with the factors that may increase or attenuate the risk, possible explanations for this phenomenom, the benefits and risks of antidepressants, the public health implications of a decline in the use of SSRIs, and recommendations for clinicians.Suicidal adverse events are treatment-emergent increases in suicidal ideation or an actual suicide attempt. In more than 4300 participants in pediatric antidepressant clinical trials, there have been no deaths by suicide, and most of these events were increases in suicidal ideation, rather than actual suicide attempts. The actual risk difference for the occurrence of an event is not large. While the FDA initially reported a risk difference of 2%, a more recent re-analysis included more recently conducted trials found a risk difference of only 0.9%, which translates to a NNH of 121. 1,2 Moreover, during the period of time when the rate of SSRI prescriptions was increasing, youth suicide rates were declining. 4 One cannot necessarily infer a causal relation between the increase in the use of SSRIs in adolescents and a decline in the adolescent suicide rate. However, if antidepressants were associated with an increased risk for suicide, one would have expected an increase in adolescent suicide, which clearly was not the case.The nature of assessment for suicidal events has also been questioned. In most clinical trials, suicidal events are not surveyed systematically, but are reported spontaneously. In fact, in the subset of clinical trials that had systematic assessment, there was no difference between medication and placebo regarding systematically assessed suicidal ideation. 2 However, other reports have shown similar rates of events, whether using usual adverse event reporting methods or by deriving the occurrence of events from systematically assessed measures of self-reported suicidal ideation. 5,6 Predictors of suicidal adverse events include previous suicidal behaviour and higher baseline levels of suicidal ideation, anger, and irritability. 5 In the Treatment of Adolescent Depression Study, 6 the rate of suicidal events was lower in the combination of antidepressant and CBT than in medication alone; however, in other clinical trials of more severely or chronically depressed youth, no protective effect was found for combination treatment. 6,7 No relation has been established among dosage, adherence pattern, medication type, and risk for events, and while some promising pharmacogenetic findings...

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Switching to Another SSRI or to Venlafaxine With or Without Cognitive Behavioral Therapy for Adolescents With SSRI-Resistant Depression

Cited by 617 publications

References 71 publications

Autolesiones no suicidas en adolescentes: revisión de los tratamientos psicológicos

Autolesiones no suicidas en adolescentes: revisión de los tratamientos psicológicos

Management of depression in children and adolescents

Selective Serotonin Reuptake Inhibitors and Suicidality: A Guide for the Perplexed

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