Children and adolescents with major depressive disorders: are some second generation antidepressants better than others?

2011 ◽  
Vol 26 (S2) ◽  
pp. 1251-1251
Author(s):  
A. Kaminski ◽  
G. Gartlehner
Keyword(s):  
Children And Adolescents ◽  
Comparative Effectiveness ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Depressive Disorders ◽  
Second Generation ◽  
Young Patients ◽  
Antidepressant Drugs ◽  
Cochrane Library ◽  
Major Depressive ◽  
Increased Risk

IntroductionSince the black box warning of the FDA (Food and Drug Administration) regarding an increased risk of suicidality in children and adolescents treated with antidepressants, cautious prescription of antidepressant drugs in young patients became even more important. In the light of potentially severe side effects the comparative effectiveness and harms of antidepressants should be known to clinicians to provide optimal treatment.ObjectivesTo compare the benefits and harms of second-generation antidepressants for the treatment of Major Depressive Disorder (MDD) in children and adolescents.AimsTo provide an evidence base for clinicians and policymakers when making informed decisions regarding the prescription of Selective Serotonin Reuptake Inhibitors and other newer antidepressants.MethodsWe updated a comparative effectiveness report of the Oregon Drug Effectiveness Review Project searching MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to August 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias.ResultsWe could not identify any head-to-head trials. There is insufficient evidence to compare one second-generation antidepressant to another in pediatric outpatients with MDD. Evidence from a systematic review of published and unpublished data indicates, that in children and adolescents only fluoxetine shows a good risk-benefit ratio.ConclusionsTo date, the evidence is insufficient to make any clear inferences about the comparative benefits and harms of second-generation antidepressants for the treatment of MDD in children. Clinicians must be aware of the small benefits and the high potential risks when prescribing antidepressant medications to children and adolescents.

scholarly journals Using marginal structural models to identify the cardiovascular adverse effects of second generation antipsychotics in children and adolescents

2015 ◽  
Vol 1 (1) ◽  
pp. 5
Author(s):  
Avnish Tripathi ◽  
George B. Black ◽  
Jeanette M. Jerrell
Keyword(s):  
South Carolina ◽  
Children And Adolescents ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Second Generation ◽  
Structural Models ◽  
Marginal Structural Models ◽  
Data Set ◽  
Pharmacy Claims ◽  
Increased Risk ◽  
Second Generation Antipsychotics

In pediatric patients, we examined the association between exposure to five second generation antipsychotics (SGAs) and incidentcardiovascular events (arrhythmic or ischemic/myocardial) over time using marginal structural models (MSM), while controllingfor salient comorbid conditions and co-prescribed psychotropic medications. A retrospective cohort, longitudinal/ observationalstudy design was used to evaluate Medicaid medical and pharmacy claims in 4140 children and adolescents prescribed SGAsfrom South Carolina USA’s Medicaid program covering outpatient and inpatient medical services and medication prescriptionsbetween January, 1996 and December, 2005. Exposure to multiple SGAs (Risk Ratio [RR]=2.37; 95% CI=1.17-4.83), coprescribedpsychostimulants (RR=1.37; CI=1.03-1.81), and comorbid hypertension (RR=2.23; CI=1.28-3.89) were associatedwith a significantly increased risk of arrhythmias compared to those not exposed, whereas exposure to co-prescribed serotoninnorepinephrine reuptake inhibitor/heterocyclic compounds was associated with a significantly decreased risk of arrhythmias(RR=0.59; CI=0.35-0.99). The risk of incident ischemic/myocardial events was significantly associated with the co-prescription ofmood stabilizers (RR=1.68; CI=1.06-2.68) or selective serotonin reuptake inhibitors (RR=1.91; CI=1.18-3.09), and the presenceof comorbid hypertension (RR=3.97; CI=1.96-8.07) and obesity (RR=2.21; CI=1.34-3.67). MSM analyses comparing multipletreatments while controlling for confounding variables in an observational, longitudinal data set provide important, differentialestimates of outcome, when randomized, controlled trials estimating low-incidence outcomes such as cardiovascular adverseevents in large pediatric patient populations are not feasible.

The comparative efficacy of second-generation antidepressants for the accompanying symptoms of depression: a systematic review

2011 ◽  
Vol 26 (S2) ◽  
pp. 697-697
Author(s):  
K. Thaler ◽  
G. Gartlehner ◽  
R.A. Hansen ◽  
L.C. Morgan ◽  
L.J. Lux ◽  
...  
Keyword(s):  
Comparative Effectiveness ◽  
Second Generation ◽  
Risk Of Bias ◽  
Low Energy ◽  
Cochrane Library ◽  
Comparative Efficacy ◽  
Major Depressive ◽  
Symptoms Of Depression ◽  
Accompanying Symptoms ◽  
The Cochrane Library

IntroductionClinicians treating patients with Major Depressive Disorder (MDD) might favor one second-generation antidepressant (SGA) because of perceived benefits for the accompanying symptoms of MDD.ObjectivesTo compare the efficacy of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for the treatment of the accompanying symptoms of MDD.MethodsThis review is part of a larger review on the comparative effectiveness of SGAs for MDD. We searched MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias.ResultsWe located 26 head-to-head and 7 placebo-controlled trials that provided evidence for this review. We did not locate any studies on treating accompanying appetite change, low energy, melancholia, or psychomotor change. There was no evidence for many comparisons and we were unable to conduct quantitative analysis for any comparisons. For the comparisons that were studied, we concluded that the SGAs are similarly efficacious for treating anxiety, insomnia, pain, and somatization. The strength of the evidence for these conclusions is low (meaning further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate).ConclusionsOur findings indicate that the existing evidence does not warrant the choice of one second-generation antidepressant over another based on greater efficacy for the accompanying symptoms of depression.

scholarly journals The association between insulin therapy and depression in patients with type 2 diabetes mellitus: a meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e020062 ◽  
Author(s):  
Xiaosu Bai ◽  
Zhiming Liu ◽  
Zhisen Li ◽  
Dewen Yan
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Insulin Therapy ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Epidemiological Studies ◽  
Cochrane Library ◽  
Increased Risk

ObjectivesSeveral patients with type 2 diabetes mellitus (T2DM) have depressive disorders. Whether insulin treatment was associated with increased risk of depression remains controversial. We performed a meta-analysis to evaluate the association of insulin therapy and depression.DesignA meta-analysis.MethodsWe conducted a systematic search of PubMed, PsycINFO, Embase and the Cochrane Library from their inception to April 2016. Epidemiological studies comparing the prevalence of depression between insulin users and non-insulin users were included. A random-effects model was used for meta-analysis. The adjusted and crude data were analysed.ResultsTwenty-eight studies were included. Of these, 12 studies presented with adjusted ORs. Insulin therapy was significantly associated with increased risk of depression (OR=1.41, 95% CI 1.13 to 1.76, p=0.003). Twenty-four studies provided crude data. Insulin therapy was also associated with an odds for developing depression (OR=1.59, 95% CI 1.41 to 1.80, p<0.001). When comparing insulin therapy with oral antidiabetic drugs, significant association was observed for adjusted (OR=1.42, 95% CI 1.08 to 1.86, p=0.008) and crude (OR=1.61, 95% CI 1.35 to 1.93, p<0.001) data.ConclusionsOur meta-analysis confirmed that patients on insulin therapy were significantly associated with the risk of depressive symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs) and Suicide in Children and Adolescents – The Debate goes on

2014 ◽  
pp. 28-30
Author(s):  
Sanjay Garg
Keyword(s):  
Mental Illness ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Children And Adolescents ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Major Depressive ◽  
Negative Impacts ◽  
Society Today

Major Depressive Disorder (MDD) is a mental illness of immense importance to the society today - more so in children and adolescents. MDD in children and adolescents has significant negative impacts on children’s development, functioning, and risk for suicide.

scholarly journals The overlap of genetic susceptibility to schizophrenia and cardiometabolic disease can be used to identify metabolically different groups of individuals

2020 ◽  
Author(s):  
Rona J. Strawbridge ◽  
Keira J. A. Johnston ◽  
Mark E. S. Bailey ◽  
Damiano Baldasarre ◽  
Breda Cullen ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Depressive Disorders ◽  
Cardiometabolic Disease ◽  
Metabolic Profiles ◽  
Uk Biobank ◽  
Major Depressive ◽  
Increased Risk ◽  
Chi Squared

AbstractUnderstanding why individuals with severe mental illness (Schizophrenia, Bipolar Disorder and Major Depressive Disorder) have increased risk of cardiometabolic disease (including obesity, type 2 diabetes and cardiovascular disease), and identifying those at highest risk of cardiometabolic disease are important priority areas for researcher. We explored whether genetic variation could identify individuals with different metabolic profiles. Loci previously associated with schizophrenia, bipolar disorder and major depressive disorder were identified from literature and those overlapping loci genotyped on the Illumina CardioMetabo and Immuno chips (representing cardiometabolic processes and diseases) were selected. In the IMPROVE study (high cardiovascular risk) and UK Biobank (general population) multidimensional scaling was applied to genetic variants implicated in both mental and cardiometabolic illness. Visual inspection of the resulting plots used to identify distinct clusters. Differences between clusters were assessed using chi-squared and Kruskall-Wallis tests. In IMPROVE, genetic loci associated with both cardiometabolic disease and schizophrenia (but not bipolar or major depressive disorders) identified three groups of individuals with distinct metabolic profiles. The grouping was replicated in UK Biobank, albeit with less distinction between metabolic profiles. This study provides proof of concept that common biology underlying mental and physical illness can identify subsets of individuals with different cardiometabolic profiles.

scholarly journals Risks of Antidepressant induced psychotic events in patients with depression and psychosis

2022 ◽  
Author(s):  
Sourav Dakua
Keyword(s):  
Literature Review ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Antidepressant Drug ◽  
Age Groups ◽  
Antidepressant Drugs ◽  
Individual Risk ◽  
Major Depressive ◽  
Compulsive Disorder ◽  
Drug Classes

The aim of this ‘literature review’-based argumentative paper has been to find out the risks of developing psychotic and depressive disorders in patients having been treated with antidepressants. In order to reach a resounding supposition, this literature review-based argumentative study had taken an incisive look into previous research works and meta-analysis, which in effect had underscored the risks of antidepressant-induced psychotic and depressive disorders in patients with depression as well as psychosis even as the protagonists of antidepressant drug classes could not be undermined given their upscaled magnitude of benefits. While following a probing interpretation of past studies, this might be demystified that antidepressants could lead to psychotic events and depressive disorders in patients of all age groups with children and young adults being more susceptible to develop psychosis. The psychotic episodes could even be developed during initial phase of treatments in patients suffering from depressive and psychotic disorders such as bipolar mood disorder, unipolar depression, major depressive disorders, mania, OCD (Obsessive Compulsive Disorder), delusional depression (psychotic depression), schizophrenia, schizoaffective disorders alongside multiple somatic symptoms among others as well. Concomitantly, with efficaciousness of antidepressants in major depressive disorder still remaining a subject to utter dubitability, different antidepressant drug classes were found to be associated with a considerable scale of adverse effects after carrying out protracted arguments on findings of evidence-based past studies, meta-analysis of previous researches and relevant clinical cases. Therefore, following a systematized approach towards past studies, this argumentative research has reached a coherent conclusion that antidepressants are likely to cause psychotic events and exaggeration of depressive disorders up to some extent in several cases. Hence, there is a stipulation of individual risk-benefit assessment and intricate history taking in patients being contemplated for antidepressant drugs alongside a close observation and follow-up in patients of all age groups after introducing antidepressant medications.

scholarly journals Anxiety disorders in children and adolescents: aetiology, diagnosis and treatment

2016 ◽  
Vol 22 (5) ◽  
pp. 335-344 ◽  
Author(s):  
Aaron K. Vallance ◽  
Victoria Fernandez
Keyword(s):  
Anxiety Disorders ◽  
Children And Adolescents ◽  
Depressive Disorders ◽  
Developmentally Appropriate ◽  
Childhood Anxiety ◽  
Behavioural Therapy ◽  
Childhood Anxiety Disorders ◽  
Cognitive Behavioural ◽  
Increased Risk ◽  
The Individual

SummaryThe presentation of anxiety disorders in children and adolescents shares similarities and differences with that in adults, and may vary significantly, depending on the age of the individual. Assessment must differentiate anxiety disorders from developmentally appropriate fears as well as medical conditions and drugs that can mimic anxiety states. Aetiology of anxiety disorders in this group encompasses complex genetic and environmental influences. Additional insight into causation is provided by neuroimaging and research into temperament. Recommended interventions include both cognitive-behavioural therapy and pharmacology. Although childhood anxiety disorders generally remit, there remains an increased risk for anxiety and depressive disorders to emerge in adulthood, most likely through heterotypical continuity.

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