PHARMACOLOGICAL TREATMENT OF MAJOR DEPRESSIVE DISORDER IN CHILDREN AND ADOLESCENTS: THE PAROXETINE CONTROVERSY

Main Article Content

Sandra N. Fisman

Keywords

paroxetine, major depressive disorder, social anxiety disorder

Abstract

Controversy  has  surrounded  the  use  of  the  selective  serotonin  reuptake  inhibitor  (SSRI) paroxetine in  children and  adolescents under  the  age  of  18  years.  Pending  further  review, paroxetine treatment for major depressive disorder (MDD) should not be initiated in youth under the age of 18 years. However, in the event that a youth with MDD has responded to paroxetine with good symptom resolution, it would be unwise to discontinue the drug. When discontinuation of paroxetine is desired, it should be undertaken with gradual tapering to prevent the emergence of  rebound  anxiety.  As  the  evidence  for  efficacy  in  social  anxiety  disorder  outweighs the evidence for use in MDD it may be appropriate to use paroxetine for social anxiety disorder in this age group with careful monitoring for the presence of suicidal ideation

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References

1. Tiecher MH, Glod C, Cole JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry 1990; 147:207-10.
2. Kahn A, Kahn S, Kolts R, Brown W. Suicide rates in clinical trials of SSRIs, other antidepressants and placebo: analysis of FDA reports. Am J Psychiatry 2003; 160(4)(:790-2.
3. Emslie GJ, Rush AJ, Weinberg, WA. A double- blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch. Gen. Psychiatry 1997; 54:1031-7.
4. Emslie GJ, Heiligenstein JH, Wagner KD. Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2002: 41:1205-15.
5. Wagner KD, Ambrosini P, Rynn M, Wohlberg C, Yang R, Greenbaum MS and others. Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder; two randomized controlled trials. JAMA: 2003:29(8) 1033-41.
6. Kellar MB, Ryan ND, Strober M. Effect of paroxetine in the treatment of adolescent major depressive disorder: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2001;40:762-72.
7. Wagner KD. Paroxetine treatment of mood and anxiety disorders in children and adolescents. Psychopharmacol Bull 2003; 37:167-75.
8. Garland EJ. Facing the evidence: antidepressant treatment in children and adolescents. CMAJ 2004; 170(4):489-91.
9. Duff G. Safety of Seroxat (paroxetine) in children and adolescents under 18 years, contraindication in the treatment of depressive illness. United Kingdom’s Department of Health’s Chairman of Committee of Safety of Medicine’s message on paroxetine. Available at: http://www.mca.gov.uk, Accessibility verified August 6, 2003
10. US Food and Drug Administration. FDA statement regarding the antidepressant Paxil for pediatric depression. FDA Talk Paper, June 19, 2003.Available at
http://www.fda.gov/bbs/topics/ANSWERS/2003/A NSO1230.html, Accessibility verified August 8, 2003
11. US Food and Drug Administration. FDA issues public health advisory entitled: reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder 27 Oct. 2003. Available at www.fda.gov/bbs/topics/ANSWERS/2003/ANSO 1256.html
12. Wyeth Pharmaceuticals. Letter to physicians August 22, 2003.
13. Kovacs M. Presentation and course of major depressive disorder during childhood and later years of the life span. J Am Acad Child Adolesc Psychiatry. 1996;35:705-715.
14. Grunbaum JA, Kann L, Kinchen SA, Williams, B, Ross, JG, Lowry, R and others. Youth risk behavior surveillance – United States, 2001. MMWR CDC Surveill Summ. 2002;51(SS-4):1-62.
15. Olfson M, Shaffer D, Marcus SC, Greenberg, T. Relationship between antidepressant medication treatment and suicide in adolescents. Arch Gen Psychiatry 2003; 50;978-81.
16. Zito MJ, Safer DJ, dosReis S, Gardner JF, Soeken K, Boles M et al. Rising prevalence of antidepressant among US youths: Pediatrics 2002;
109(5): 721-7.
17. Goodwin R, Gould MS, Blanco C, Olfson M. Prescription of psychotropic medications to youths in office-based practice. Psychiatr Serv.
2001;52:1081.
18. Wilens TE, Biederman J, Kwon A, Chase R, Greenberg L, Mick E et al. A systematic chart review of the nature of psychiatric adverse events in children and adolescents treated with selective serotonin reuptake inhibitors, J. Child Adolesc. Psychopharmacol. 2003; 13 (2), 143 – 152.