Magazine article Clinical Psychiatry News

SSRIs Stand Alone in Treating Pediatric Depression. (Fluoxetine Maintains Recovery)

Magazine article Clinical Psychiatry News

SSRIs Stand Alone in Treating Pediatric Depression. (Fluoxetine Maintains Recovery)

Article excerpt

HONOLULU -- New data confirm the effectiveness of selective serotonin reuptake inhibitors in treating major depression in children and adolescents, Dr. Graham J. Emslie said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Dr. Joseph Biederman, professor of psychiatry at Harvard Medical School, Boston, concurred in comments made separately at the meeting: "We are beginning to have a hint of a story that SSRIs (selective serotonin reuptake inhibitors) are the only drugs that work for major depressive disorder in children and adolescents."

Dr. Emslie presented data from the second randomized, double-blind, controlled trial showing that fluoxetine effectively treated major depressive disorder in children and adolescents. He also reported results from the first trial to look at maintenance of improvements from acute therapy with SSRIs, showing that fluoxetine helped maintain results.

In the multicenter acute-treatment trial, 219 outpatients aged 8-17 years (56% under age 13) underwent a 2-week drug washout period and a 1-week placebo lead-in period before being randomized to 9 weeks of treatment with placebo or with 10mg/day fluoxetine for 1 week followed by 20 mg/day for 8 weeks. A larger proportion of patients in the fluoxetine group completed the study (83%), compared with those on placebo (62%), reported Dr. Emslie, professor of psychiatry and chair of child psychiatry at the University of Texas Southwestern Medical Center, Dallas.

After 9 weeks of treatment, depression was much or very much improved in 52% of patients on fluoxetine and 36% of patients on placebo as measured by the Clinician's Global Impression (CGI) severity scale. Depression remitted in 41% on fluoxetine and 20% on placebo. There were no differences between groups in safety measures such as sitting heart rate, sitting blood pressures, or temperature.

In the maintenance trial, children and adolescents with major depressive disorder who responded to 19 weeks of 20-60 mg fluoxetine were randomized to continue on fluoxetine or placebo for 32 weeks. Depression recurred in 34% of fluoxetine patients and 60% of those on placebo. The mean time to relapse was 181 days for fluoxetine; 71 days for placebo.

A statistically significant difference between groups in sitting systolic blood pressure was deemed clinically insignificant.

The two trials were funded by Eli Lilly and Co., the maker of fluoxetine. The company also paid Dr. Emslie as a consultant.

A previous controlled trial of fluoxetine in children and adolescents randomized 96 patients aged 8-18 years to 8 weeks of 20 mg of fluoxetine or placebo. Depression improved in 56% of patients on fluoxetine, 33% on placebo, about the same results seen in studies of adults, he noted (Arch. …

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