Quali farmaci sono disponibili per curare la depressione di adolescenti e bambini?

La redazione del sito stà preparando un corposo materiale sul tema della cura dei disturbi dell'umore nei bambini e negli adoloscenti, disturbi che sono ampiamente e ingiustificatamente sottovalutati nella pratica clinica.

Iniziamo con una recentissima nota riassuntiva della conferenza per la salute dei bambini della Pediatric Academic Societies (PAS) e della American Academy of Pediatrics (AAP).

Si rimanda anche alla letura dell'articolo sulla depressione nell'adolescenza.

Traduzione in italiano? CLICCA QUI'

Source: Inder T.: Advances and application of psychopharmacology in pediatrics. Conference summary from Advancing Children's Health 2000: Pediatric Academic Societies (PAS) and the American Academy of Pediatrics (AAP) Year 2000 Joint Meeting.

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Drug therapies in children and adolescents can include the following: 1. Tricyclic antidepressants, which have been shown to work in open studies but not in blinded studies. Their side effects are also significant. 2. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed by family physicians and pediatricians. Of the physicians surveyed recently, 72% had prescribed an SSRI for a child or adolescent, while only 8% felt that they had adequate knowledge regarding childhood depression and its therapy.[1] A variety of SSRIs for the treatment of childhood depression now exist. Fluoxetine, 20 mg/day for 8 weeks, was shown to produce improvement in 56% of depressed patients vs 33% improvement in patients on placebo.[2] The clinical benefits and safety of paroxetine (PXT) in a group of patients younger than 14 years old with a diagnosis of major depressive disorder have been studied in an open-label trial. All patients experienced marked improvement by 2 months with a complete remission of symptoms by the end of treatment (mean 8.4 months). PXT was well tolerated.[3] Sertraline produced improvement in 40% to 60% of patients by 6 weeks and 70% to 80% of patients by 10 weeks. Adult dosages should be prescribed for adolescents. There were no echocardiogram or blood pressure changes noted using sertraline 200 mg/day. Side effects associated with serotonergic agents include insomnia, anxiety, and agitation, as well as reduced libido and anorgasmia.[4-6] 3. 5HT2 and 5HT2,3 antagonists -- nefazodone and mirtazapine -- have a combined noradrenergic and serotonergic effect and appear to be as effective as SSRIs, with fewer adverse effects.[7] Depression in childhood is a significant disorder and differs from adult depression in several ways. Children exhibit more somatic symptoms, a more chronic course, and a different pharmacologic response (serotonergic drugs being more effective in children than in adults).

References

1. Rushton JL, Clark SJ, Freed GL. Pediatrician and family physician prescription of SSRIs. Pediatrics. 2000;105:E82.

2. Emslie GJ, Rush AJ, Weinberg WA, et al. A double blind randomised placebo controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry. 1997;54:1031-1037.

3. Rey-Sanchez F, Gutierrez-Casares JR. Paroxetine in children with major depressive disorder: an open trial. J Am Acad Child Adolesc Psychiatry. 1997;36:1443-1447.

4. Ambrosini PJ, Wagner KD, Biederman J, et al. Multicenter open-label sertraline study in adolescent outpatients with major depression. J Am Acad Child Adolesc Psychiatry. 1999;38:566-572.

5. Alderman J, Wolkow R, Chung M, Johnston HF. Sertraline treatment of children and adolescents with obsessive-compulsive disorder or depression: pharmacokinetics, tolerability and efficacy. J Am Acad Child Adolesc Psychiatry. 1998;37:386-394.

6. Wilens TE, Biederman J, March JS, et al. Absence of cardiovascular adverse effects of sertraline in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1999;38:573-577.

7. Holm KJ, Markham A. Mirtazapine: a review of its use in major depression. Drugs. 1999;57:607-631.

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