Antidepressants of Choice in Adolescents

Q: Which of the following antidepressant is first line for moderate or severe depression treatment in adolescents?

 


 

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A Cochrane systematic review was done to answer this question: this review included 19 randomized controlled trials including total of3335 patients.

 

Medications included: fluoxetine, sertraline, escitalopram, citalopram, paroxetine, venlafaxine, and mirtazapine.

 

Symptom severity score used: Children’s Depression Rating Scale- Revised [CDRS-R].

 

 


SSRIs that slightly lowered one symptom severity score on CDRS-R:

 

  1. Fluoxetine

  2. Sertraline

  3. Escitalopram

 

  • These three medications did not significantly increased suicide related outcomes.

  • Among other medications: only venlafaxine increased suicide related outcomes.

 


 

According to updated NICE guidances (2) following recommendations are provided for moderate to severe depression management in adolescents:

 

  • First line: fluoxetine.

  • Second line: citalorpam or sertaline.

 

 


Source:
  1. J Fam Pract. 2016 September;65(9):632-634.
  2. BMJ. 2015;350:h824.

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Dr. Harvinder Singh, M.D. (Admin)


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