Second Generation Antidepressants for Pediatric Patients with Major Depressive Disorder and Anxiety Disorder: A Review of the Clinical Effectiveness and Safety [Internet]

Excerpt

Major depressive disorders (MDD) and anxiety disorders fall within a spectrum of psychiatric disorders that are characterized by severe and/or persistent symptoms of sadness and irritability that can cause considerable distress and interfere with daily activities. Untreated, they may lead to serious developmental, personal and societal difficulties that may prejudice school success, work productivity, adult development and the forming of relationships. In Canada, it is estimated that approximately 5% of male youth and 12% of female youth have experienced a major depressive episode during their childhood or adolescent years.

Patients suffering from such conditions may require psychological (i.e. cognitive behavioral therapy (CBT)) and/or pharmacological treatment such as second generation antidepressants (i.e., selective serotonin reuptake inhibitors [SSRI] and selective norepinephrine reuptake inhibitors [SNRI]). Early studies on second generation antidepressants suggest that they are well tolerated in young people, although it remains a controversial issue as some studies have suggested an unfavorable risk-benefit profile due to higher risks of suicidality (i.e., worsening suicidal thoughts and self-harm behavior). In 2003, Health Canada issued warnings and placed ‘black box’ labels on the monographs of antidepressants given these concerns. Despite marked reductions in the volume of antidepressant prescriptions by Canadian youths since these warnings, subsequent studies have noted lowered utilization of psychotherapy and mental health services in addition to an increased suicide rate among youths. Both the 2008 revised Canadian Network for Mood and Anxiety Treatments (CANMAT) guideline (co-sponsored by CANMAT and the Canadian Psychiatric Association) and a 2008 position paper on SSRI use (endorsed by the Canadian Psychiatric Association and the College of Family Physicians of Canada) have since suggested that there is evidence supporting a modest efficacy for SSRI and SNRI for the treatment of depression and anxiety in pediatric patients. If applied properly and monitored closely, patients may stand to benefit substantially with a small risk of increased suicidality. It is uncertain the extent to which new evidence reporting the clinical effectiveness and safety of second generation antidepressants has become available in the time since these guidelines were published.

The purpose of this Rapid Response report is therefore to assess the available evidence regarding the clinical effectiveness of second generation antidepressants in a pediatric population. This summary and review of recent clinical evidence may be useful towards supporting the development of evidence-based recommendations on the role and optimal prescribing of these second-generation antidepressants for pediatrics.