NEWER ANTIDEPRESSANTS: Beyond Selective Serotonin Reuptake Inhibitor Antidepressants

摘要: Major depressive disorder in children and adolescents is a significant problem also predictive indicator of severe long-term difficulties. 22,43 Although the phenomenology child adolescent depression versus adult held to be similar, 51 has not been shown clearly respond treatment with tricyclic antidepressants (TCAs) double-blind studies. More evidence may available for than adolescents. 1a,19,42 These generally negative findings have reviewed, 20 sudden unexplained deaths receiving desipramine 29,32,33,39 caused widespread concern about use TCAs Citing lack rigorous scientific supporting superiority compared placebo, along these deaths, Geller 17 Werry 52 expressed routine As noted article by Labellarte colleagues elsewhere this issue, emergence selective serotonin reuptake inhibitors (SSRIs) allowed further psychopharmacologic methods treating depression. Fluoxetine, fluvoxamine, sertraline, paroxetine found open studies provide effective antidepressant activity without sedating, anticholinergic, or cardiotoxic reactions observed TCAs, although incidence insomnia, nervousness, restlessness, anxiety are higher. 4,21,50 McConville 25 positive effects sertraline major that scale ratings frequently varied, being worsened adverse events improved life circumstances. There an endogenous component early childhood adolescence, either as pure syndrome following repeated stressors. 34 If stressors can lead nonreactive pattern, strong argument made psychotherapeutic intervention disorders double depressions (e.g., dysthymia disorder). Follow-up depressives suggests become long-term, causing debilitating problems, including only but impairment psychosocial educational functioning. 23,37 A few on SSRIs conducted. Simeon 45a did find statistically differences between fluoxetine placebo depression; however, important study Emslie colleagues, 12 which 96 were treated difference was among untreated groups Children's Depression Rating Scale Revised 36 Clinical Global Impression 28 In study, effect similar drug first week outpatient treatment; over 8-week period trial, emerged criteria earlier. 3 Therefore, efficacy exist both depressed provided sufficiently large sample used indicate response. addition, careful measurements must taken within single centers ensure inter-rater reliability. current clinical preference rather depression, hard from controlled minimal. Moreover, connection effectiveness medications their degree inhibition seems lacking. Further "traditional" needed, multidose disorders; needed more exploration newer alternate antidepressive agents. The section begins overview compounds leads into discussion most common practitioners, well some developments.