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. 2011 Nov;16(9):549-53.
doi: 10.1093/pch/16.9.549.

Antidepressant use in children and adolescents: Practice touch points to guide paediatricians

Tim F Oberlander  1 , Anton R Miller
Affiliations

Antidepressant use in children and adolescents: Practice touch points to guide paediatricians

Tim F Oberlander et al. Paediatr Child Health. 2011 Nov.

Abstract
in English, French

Depression in children and youth is common, and requires an understanding of its developmental character and associated comorbid conditions. Initial treatment of mild depression involves active supportive measures with a focus on symptom reduction and improved daily function. Where pharmacotherapy is warranted, evidence supports the use of selective serotonin reuptake inhibitor (SSRI) antidepressants, particularly fluoxetine, to manage moderate/severe depression. SSRI treatment should include a comprehensive management plan in the context of interdisciplinary care, an understanding of its pharmacology and clearly articulated goals for symptom reduction, functional status tracking (school, home and peers) and monitoring for the emergence of suicidal ideation/behaviour. For children with more severe symptoms or complicating factors (comorbid conditions), referral to mental health clinicians should be considered. Use of an SSRI should be associated with family/patient education about medication effects, specific social and health goals that promote self-esteem, improved function and close monitoring for adverse effects.

La dépression est courante chez les enfants et les adolescents. Il faut en comprendre la nature développementale et les pathologies comorbides. Le traitement initial d’une dépression bénigne comporte des mesures de soutien actives axées sur la diminution des symptômes et l’amélioration du fonctionnement quotidien. Lorsqu’une pharmacothérapie s’impose, les données probantes appuient l’utilisation d’antidépresseurs sous forme d’inhibiteurs spécifiques du recaptage de la sérotonine (ISRS), notamment la fluoxétine, pour prendre en charge la dépression modérée à profonde. Le traitement aux ISRS doit s’associer à un plan de prise en charge détaillé dans un contexte de soins interdisciplinaires, à la compréhension de sa pharmacologie ainsi qu’à des objectifs bien établis de réduction des symptômes, de suivi de l’état fonctionnel (à l’école, à la maison et avec les camarades) et de suivi de l’émergence d’idéations ou de comportements suicidaires. Chez les enfants qui présentent des symptômes plus graves ou des facteurs de complication (pathologies comorbides), il faut envisager un aiguillage vers un clinicien en santé mentale. Avant de prescrire un ISRS, il faut informer la famille et le patient des effets du médicament, des objectifs sociaux et sanitaires qui favorisent l’estime de soi, de l’amélioration du fonctionnement et du suivi étroit des effets indésirables.

Keywords: Depression in children and youth; Management of depression in a paediatric community setting; Selective serotonin reuptake inhibitor (SSRI) antidepressants.

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