Study supports SSRI use for depression in children
Evidence to support the use of sertraline (Lustral) as a treatment for depression in children and adolescents has been published in JAMA (2003;290:1033).
Researchers from the United States show that this selective serotonin
reuptake inhibitor (SSRI) improved the symptoms of major depressive disorder
more effectively than placebo in a study of 376 patients aged between
six and 17 years.
They report that sertraline was generally well tolerated in the 10-week
trial, although more patients receiving active drug (9 per cent) than
placebo (3 per cent) discontinued treatment because of adverse events.
The researchers note that the incidence of discontinuations was similar
among adolescents treated with sertraline and adolescents given placebo,
whereas for children there was a higher proportion of discontinuations
among the active treatment group.
“The nature of this difference is unclear,” they say. However,
they suggest that reduced initial doses or slower titration of sertraline
in children may improve tolerability (sertraline was titrated from 50mg
per day up to a maximum of 200mg per day depending on clinical response).
The use of SSRIs in children came under the spotlight recently when the
Medicines and Healthcare products Regulatory Agency issued
a warning about suicide risk and the use of paroxetine (Seroxat) (PJ, 14 June,
p813). In the current study, there were suicide attempts by two patients
in the group treated with sertraline and two patients in the group given
placebo. Three patients treated with sertraline showed signs of suicide
ideation and one patient in this group displayed an aggressive reaction.
In an accompanying editorial (ibid, p1091), Dr Christopher Varley, University
of Washington school of medicine, Seattle, concludes that current evidence
supports the use of SSRIs, particularly fluoxetine and sertraline, in
the treatment of major depressive disorder in children and adolescents. |
