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Children Taking Selective Serotonin Re-Uptake Inhibitors At
Risk Of Treatment-Emergent Psychiatric Adverse Events
A DG Review of :”A systematic chart review of the nature of
psychiatric adverse events in children and adolescents
treated with selective serotonin reuptake inhibitors”
Journal of Child and Adolescent Psychopharmacology
[By Guy Furness.]
Children taking selective serotonin re-uptake inhibitors
(SSRIs) are at risk for developing psychiatric adverse
events (PAEs), which emerge within a few months of
beginning treatment and resolve on discontinuation ,
according to a US study.
The systematic review of unselected medical records, led by
Timothy Wilens, MD, of Massachusetts General Hospital,
Boston, United States, involved 82 children and adolescents
(aged 3 to 18 years) with depression or obsessive
compulsive disorder (OCD), who had been treated
naturalistically with citalopram, fluoxetine, fluvoxamine,
paroxetine or sertraline. They were identified from a
sample of all children consecutively referred to the
hospital’s paediatric psychopharmacology clinic between
1993 and 2000.
Of the 82 subjects, 18 (22%) experienced an SSRI treatment-
emergent PAE, with mood disturbance being the most common.
The researchers noted that their data, combined with the
existing scientific literature suggested that sleep
disturbance and agitation were among the most common.
Behavioural activation was less common but tended to be
more serious, they said.
The median time to onset of treatment-emergent PAEs was 91
days, and in 25% of children with PAEs, they emerged within
35 days. In the study, SSRIs were discontinued when PAEs
emerged. Half of PAEs had resolved within 28 days of
discontinuing SSRIs, and 75% had resolved within 49 days.
The researchers commented: “The complete and rapid
remission of the PAEs upon SSRI discontinuation further
supports the notion that the PAEs were probably related to
the SSRI.”
It was also shown that patients whose PAEs arose more
rapidly had a more rapid resolution of the event after SSRI
discontinuation. Re-exposure to an SSRI following
resolution of a PAE resulted in another PAE occurring in 8
of 18 subjects. Noting that the study had limitations, the
researchers said that a better understanding of the onset
of PAEs relative to SSRIs was required but, until then,
children should be monitored for the onset of PAEs for the
first few months of treatment.
There were no associations found between the development of
a PAE and either the child’s sex; whether the child had OCD
or depression; presence of concurrent medication; or the
type of SSRI being taken.
The researchers suggested that discussing with the families
the potential for adverse events when using SSRIs in
children and adolescents was warranted and, furthermore,
might “enhance recognition and dampen the deleterious
impact of this idiosyncratic reaction.” J Child Adolescent
Psychopharmacol 2003;13:2:143-152.
“A systematic chart review of the nature of psychiatric
adverse events in children and adolescents treated with
selective serotonin reuptake inhibitors”