10 Jun Fluoxetine – Prozac – May Be Best Choice For Pediatric and Adolescent Depression

MedicalResearch.com Interview with:

Dr. Andrea Cipriani

Andrea Cipriani, MD PhD
Associate Professor
Department of Psychiatry
University of Oxford
Warneford Hospital
Oxford UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Cipriani: Major depressive disorder is common in young people, with a prevalence of about 3% in school-age children (aged 6–12 years) and 6% in adolescents (aged 13–18 years). Compared with adults, children and adolescents with major depressive disorder are still underdiagnosed and undertreated, possibly because they tend to present with rather undifferentiated depressive symptoms—eg, irritability, aggressive behaviours, and school refusal. Consequences of depressive episodes in these patients include serious impairments in social functioning, and suicidal ideation and attempts. Our analysis represents the most comprehensive synthesis of data for currently available pharmacological treatments for children and adolescents with acute major depressive disorder (5620 participants, recruited in 34 trials).

Among all antidepressants, we found that only fluoxetine was significantly better than placebo. According to our results, fluoxetine should be considered the best evidence-based option among antidepressants when a pharmacological treatment is indicated for children and adolescents with moderate to severe depression. Other antidepressants do not seem to be suitable as routine treatment options.

MedicalResearch.com: What should readers take away from your report?

Response: In the clinical care of young people with major depressive disorder, clinical guidelines recommend psychotherapy (especially cognitive-behavioural therapy or interpersonal therapy) as the first-line intervention. Fluoxetine should be considered only for patients who do not have access to psychotherapy (especially in low-income and middle-income countries) or have not responded to non-pharmacological interventions.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Cipriani: Future studies should understand the differences and peculiarities of major depression in young people and identify strong markers of disease and predictors of response for this disorder. New randomised controlled studies should then adopt a superiority design and probably use fluoxetine as comparator, not just placebo (new drugs should not be “me-too” drugs, but they should be more effective tools to tackle depression)

MedicalResearch.com: Is there anything else you would like to add?

Dr. Cipriani: It is important to avoid a one-size-fits-all approach. If a child or adolescent is taking an antidepressant that works for his/her depression, it should not be changed to fluoxetine. The bottom line message of this analysis is that, if we need to start a pharmacological treatment for a moderate to severe depressive episode in young people, fluoxetine is the first drug to consider, as it has the best profile combining efficacy and tolerability.

The second take home message is that some antidepressants (especially venlafaxine) may increase suicidality in children and adolescents. Considering the limitation in the quality of available data, however, we should not underestimate these potential risks. Children and adolescents taking antidepressant drugs should be closely monitored regardless of the treatment chosen, particularly at the beginning of treatment.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 10, 2016 by Marie Benz MD FAAD