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Context: Only about 60% of adolescents with depression will show an adequate clinical response to an initial treatment trial with a selective serotonin reuptake inhibitor (SSRI). There are no data to guide clinicians on subsequent treatment strategy.Objective: To evaluate the relative efficacy of 4 treatment strategies in adolescents who continued to have depression despite adequate initial treatment with an SSRI.Design, Setting, and Participants: Randomized controlled trial of a clinical sample of 334 patients aged 12 to 18 years with a primary diagnosis of major depressive disorder that had not responded to a 2-month initial treatment with an SSRI, conducted at 6 US academic and community clinics from 2000-2006.Interventions: Twelve weeks of: (1) switch to a second, different SSRI (paroxetine, citalopram, or fluoxetine, 20-40 mg); (2) switch to a different SSRI plus cognitive behavioral therapy; (3) switch to venlafaxine (150-225 mg); or (4) switch to venlafaxine plus cognitive behavioral therapy.Main Outcome Measures: Clinical Global Impressions-Improvement score of 2 or less (much or very much improved) and a decrease of at least 50% in the Children's Depression Rating Scale-Revised (CDRS-R); and change in CDRS-R over time.Results: Cognitive behavioral therapy plus a switch to either medication regimen showed a higher response rate (54.8%; 95% confidence interval [CI], 47%-62%) than a medication switch alone (40.5%; 95% CI, 33%-48%; P = .009), but there was no difference in response rate between venlafaxine and a second SSRI (48.2%; 95% CI, 41%-56% vs 47.0%; 95% CI, 40%-55%; P = .83). There were no differential treatment effects on change in the CDRS-R, self-rated depressive symptoms, suicidal ideation, or on the rate of harm-related or any other adverse events. There was a greater increase in diastolic blood pressure and pulse and more frequent occurrence of skin problems during venlafaxine than SSRI treatment.Conclusions: For adolescents with depression not responding to an adequate initial treatment with an SSRI, the combination of cognitive behavioral therapy and a switch to another antidepressant resulted in a higher rate of clinical response than did a medication switch alone. However, a switch to another SSRI was just as efficacious as a switch to venlafaxine and resulted in fewer adverse effects.Trial Registration: clinicaltrials.gov Identifier: NCT00018902. [ABSTRACT FROM AUTHOR]

Emslie G, Judge R. Tricyclic antidepressants and selective serotonin reuptake inhibitors: use during pregnancy, in children/adolescents and in the elderly. Acta Psychiatr Scand 2000: 101: 26-34. © Munksgaard 2000. Objective: Depressive disorders can occur at any point in the lifespan. One way of differentiating antidepressants is by examining their efficacy and safety in the special patient populations that exist along the lifespan. Thus, we examine clinical data that is available regarding the use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) at three distinct points in the lifespan: childhood and adolescence, pregnancy and late adulthood. Method: Literature regarding the use of antidepressants in children and adolescents, pregnancy and the elderly was reviewed. Results: Clinical data suggest that SSRIs should be first line treatment in children and adolescents as TCAs have questionable efficacy and definite safety issues. Similarly, although TCAs and SSRIs show equivalent efficacy in elderly patients, the safety profile of the SSRIs makes them a more prudent choice in this population. Finally, although there is no definitive data that contraindicates the use of a particular antidepressant in pregnancy, the bulk of reassuring pregnancy outcome data exists for the SSRIs, specifically for fluoxetine. Conclusion: Although no single antidepressant can ever be recommended for every patient, SSRIs should be considered the first-line choice in the treatment of depression in special patient populations. [ABSTRACT FROM AUTHOR]

The objective was to present naturalistic 1-year follow-up information of 96 child and adolescent outpatients with major depressive disorder who had been randomized in an 8-week double-blind, placebo-controlled trial of fluoxetine. Subjects were children and adolescents, ages 8-18 years, who were entered in a randomized clinical trial of fluoxetine. Following the acute treatment trial, treatment was not controlled. At 6 months and 1 year, the subjects and parents were interviewed using the Kiddie Longitudinal Interval Follow-up Evaluation (K-LIFE) for course of depression. Eighty-seven of the 96 subjects were followed for 1 year. Of these, 74 (85%) recovered from the depressive episode during that time (47 on fluoxetine, 22 on no medication, and 5 on other antidepressants or lithium). Twenty-nine of the subjects (39%) who recovered had a recurrence of depression during the 1-year follow-up, with 55% of these occurring within 6 months. Results of this study are similar to adult studies, with respect to response and recovery of depressive episodes. Most patients (85%) recover from the episode within 1 year, but approximately 40% have a recurrence within 12 months, which is a higher recurrence rate than in adults. Recovery was associated with younger age, lower severity of depressive symptoms, higher family functioning, and fewer comorbid diagnoses. Recurrence, which occurs both on and off medication, was difficult to predict, as there was little clinical data associated with recurrence in this population. [ABSTRACT FROM AUTHOR]

The article presents information on a study that analyzed the effectiveness of oxcarbazepine in the treatment of children and adolescents with bipolar I disorder(BP-I). The manic symptoms between oxcarbazepine and placebo were found to be the same. It was concluded that oxcarbazepine increases adverse events and does not improve BP-I manic symptoms as compared with placebo.

The article presents a study on the validity of Mood Disorder Questionnaire (MDQ) for adolescents as a screening instrument for bipolar disorder in psychiatric outpatient clinics. It discusses the design method used, the clinical setting, number of patients, test questionnaire, diagnostic standard and outcomes. The results shows that the parental report version of the MDQ provides a better sensitivity for diagnosis of bipolar disorders than self report in outpatient clinics.