Treating major depression in children and adolescents
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《英国医生杂志》
EDITOR—Ramchandani's editorial focuses entirely on the use of selective serotonin reuptake inhibitors in the treatment of major depressive disorder, just as did the statements of the chairman of the Committee on Safety of Medicines on which he comments.1 Did he not think it odd that the statement said nothing about obsessive-compulsive disorder, panic disorder, social phobia, or general anxiety disorder, for which various selective serotonin reuptake inhibitors are also prescribed?
The committee does not say whether the use of these drugs for these conditions in people under 18 is justified and appropriate. Presumably the committee's expert working group is considering these questions, but that requires a clear official statement now.
The British National Formulary notes the following indications2:
Citalopram:panic disorder child not recommended (adolescent not mentioned)
Escitalopram: child and adolescent under 18 not recommended (strange, since it is virtually identical with citalopram)
Fluoxetine: bulimia, obsessive-compulsive disorder, child not recommended (adolescent not mentioned)
Fluvoxamine: obsessive-compulsive disorder, indicated for children over 8
Paroxetine: obsessive-compulsive disorder, panic disorder, social phobia, general anxiety disorder, child not recommended (adolescent not mentioned)
Sertraline: obsessive-compulsive disorder, indicated for children over 6 and adolescents; post-traumatic stress disorder, child not recommended (adolescent not mentioned)
Venlafaxine: general anxiety disorder, child and adolescent under 18 not recommended
It may be too late for the Committee on Safety of Medicines and Medicines and Healthcare Products Regulatory Agency to unravel this confusion in time for the March edition of the formulary, but that makes it especially urgent for them to issue a clear statement that will help prescribers, as well as patients and their parents.
Andrew Herxheimer, emeritus fellow
UK Cochrane Centre London N3 2NL andrew_herxheimer@compuserve.com
Competing interests: None declared.
References
Ramchandani P. Treatment of major depressive disorder in children and adolescents. BMJ 2004;328: 3-4. (3 January.)
British Medical Association, Royal Pharmaceutical Society of Great Britain. British national formulary. London: BMA, RPS, 2003(September): 193-7.
The committee does not say whether the use of these drugs for these conditions in people under 18 is justified and appropriate. Presumably the committee's expert working group is considering these questions, but that requires a clear official statement now.
The British National Formulary notes the following indications2:
Citalopram:panic disorder child not recommended (adolescent not mentioned)
Escitalopram: child and adolescent under 18 not recommended (strange, since it is virtually identical with citalopram)
Fluoxetine: bulimia, obsessive-compulsive disorder, child not recommended (adolescent not mentioned)
Fluvoxamine: obsessive-compulsive disorder, indicated for children over 8
Paroxetine: obsessive-compulsive disorder, panic disorder, social phobia, general anxiety disorder, child not recommended (adolescent not mentioned)
Sertraline: obsessive-compulsive disorder, indicated for children over 6 and adolescents; post-traumatic stress disorder, child not recommended (adolescent not mentioned)
Venlafaxine: general anxiety disorder, child and adolescent under 18 not recommended
It may be too late for the Committee on Safety of Medicines and Medicines and Healthcare Products Regulatory Agency to unravel this confusion in time for the March edition of the formulary, but that makes it especially urgent for them to issue a clear statement that will help prescribers, as well as patients and their parents.
Andrew Herxheimer, emeritus fellow
UK Cochrane Centre London N3 2NL andrew_herxheimer@compuserve.com
Competing interests: None declared.
References
Ramchandani P. Treatment of major depressive disorder in children and adolescents. BMJ 2004;328: 3-4. (3 January.)
British Medical Association, Royal Pharmaceutical Society of Great Britain. British national formulary. London: BMA, RPS, 2003(September): 193-7.