Use of selective serotonin reuptake inhibitors in childhood depression
Use of selective serotonin reuptake inhibitors in childhood depression
The Lancet, Vol 364, No. 9435, August 2004
By Alen J. Salerian, MD
Craig Whittington and colleagues (1) should be commended for alerting all health-care professionals to the potential dangers in the treatment of depressed children and adolescents. However, they should have discussed the potential limitations in their study, such as the dose-response relation, and the relation between the key variables independent of medication and response, as contributors to poor outcome or increased adverse events, including suicide. For example, what if inadequate dose or the inclusion of patients with future adult-onset bipolar disorder contributed to poor outcome or to suicide? The lack of discussion on the potential limitations of the study makes it inappropriate to conclude that “the possibility that a drug might increase [the risk of suicide] without clear evidence of benefit, should, in our view, discourage its use”.
Future research is urgently needed in the following areas: development of genetic, biological, clinical, and familial markers to identify depressed children and adolescents at high risk of adverse responses to antidepressant treatment (ie children with future adult-onset bipolar illness, schizoaffective disorder, or schizophrenia); definition of the standards of care and close monitoring of adverse side effects; development of an exclusion criterion for children and adolescents potentially at high risk of adverse reactions; and development of special protocols of standard care for depressed children and adolescents who might represent a high risk of adult-onset bipolar or schizoaffective disorder.
(1) Whittington CJ, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Boddington E. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 2004;363: 1341-45.