Newer Antidepressants Provide Hope for Effective Drug Treatment of Depression in Children and Adolescents
Q.Major depression is a common, debilitating and potentially life-threatening disorder. When compared with the pharmacological treatment of major depressive episodes during adulthood, relatively little is known about the pharmacological treatment of depression during the paediatric years. Because of disappointing results and the significant potential for adverse effects with tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), neither of these drug classes can be recommended for the treatment of depression in children and adolescents. However, several newer medications, including the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs), hold promise for the treatment of this patient group, mainly because these drugs are relatively well tolerated (see Differential features table). To date, none of these agents have been approved for use in children.
A.Depressive disorders are leading causes of morbidity and mortality in young people. The prevalence of major depressive disorders is estimated to be approximately 2% in children and 4 to 8% in adolescents. Although occurring at approximately the same rate in girls and boys during childhood, a 2-to-1 ratio becomes evident during adolescence. Children and adolescents with depression may present for treatment because of problems that are not initially evident as depression.[1] For example, children may present with nonspecific physical complaints (stomachache, headache) or because of negative irritable mood leading to oppositional behaviours and refusal to do school work or attend school. In adolescents, the presenting problem may be suicidal thoughts or behaviours or antisocial behaviour, including substance abuse. The current diagnostic criteria for a major depressive episode are essentially the same for children, adolescents and adults (see table 1).[4] The diagnosis of depression in children and adolescents may be complicated, however, by a number of factors including the presence of general paediatric conditions (including neurological, endocrinological and metabolic conditions) that may mimic a major depressive episode. Moreover, often depression is not diagnosed, and therefore never treated, in children and adolescents because depressive symptomatology is often considered 'just a phase'.[5]
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