Efficacy of selective serotonin reuptake inhibitor treatment in children and adolescents

Efficacy of selective serotonin reuptake inhibitor treatment in children and adolescents Selective serotonin reuptake inhibitors (SSRIs) have been used increasingly since the early 1990s to treat anxiety disorders and depression in children and adolescents. Several recent reports, however cost doubt on their efficacy and especially raise questions about their role in serious adverse effects (increase in suicidal ideation and suicide attempts as well as reactions involving irritability hostility self-harm and self-destructive actions). The efficacy of SSRIs (fluoxetine, sertraline, fluvoxamine, poroxetine) in the treatment of obsessive-compulsive disorders in this population is clear today although their effects are globally relatively modest. SSRls remain notably less effective than clomipramine for this indication, although a variety of factors (age, family history and psychiatric comorbidity) ore also likely to influence response to treatment. Only several placebo-controlled studies suggest that the SSRls (fluoxetine, sertraline and fluvoxamine) may hove some utility in the treatment of anxiety disorders (generalized anxiety, Separation anxiety social phobias) in children and teens. The additional benefits from SSRls for this indication nonetheless require confirmation. Imipramine and related tricyclic antidepressants ore ineffective in the treatment of depressive disorders in children and adolescents. Among the SSRIs, only fluoxetine has proven its efficacy for this indication, although its effect here too appears relatively modest. The efficacy of sertraline and paroxetine cannot be considered more than probable, requiring confirmation, and that of citalopram has not been demonstrated. Moreover because of the risk of suicidal behavior observed in some studies, SSRls are inadvisable for the treatment of depressive disorders in this population. Overall, although the currently available data show SSRls to be moderately effective and useful in treating anxiety disorders and depression in children and adolescents, future studies must focus on more precise identification of their indications, especially relative to psychotherapeutic strategies, which are still considered to be the first-line treatment in these disorders. From a legal point of view, only sertraline has been authorized in France for the treatment of obsessive-compulsive disorders in this population.