Carroll W Hughes1, Graham J Emslie2, M Lynn Crismon2, Kelly Posner2, Boris Birmaher2, Neal Ryan2, Peter Jensen2, John Curry2, Benedetto Vitiello2, Molly Lopez2, Steve P Shon2, Steven R Pliszka2, Madhukar H Trivedi2. 1. Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio. Electronic address: carroll.hughes@utsouthwestern.edu. 2. Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Abstract
OBJECTIVE: To revise and update consensus guidelines for medication treatment algorithms for childhood major depressive disorder based on new scientific evidence and expert clinical consensus when evidence is lacking. METHOD: A consensus conference was held January 13-14, 2005, that included academic clinicians and researchers, practicing clinicians, administrators, consumers, and families. The focus was to review, update, and incorporate the most current data to inform and recommend specific pharmacological approaches and clinical guidance for treatment of major depressive disorder in children and adolescents. RESULTS: Consensually agreed on medication algorithms for major depression (with and without psychosis) and comorbid attention-deficit disorders were updated. These revised algorithms also incorporated approaches to address issues of suicidality, aggression, and irritability. Stages 1, 2, and 3 of the algorithm consist of selective serotonin reuptake inhibitor and norepinephrine serotonin reuptake inhibitor medications whose use is supported by controlled, acute clinical trials and clinical experience. Recent studies provide support that selective serotonin reuptake inhibitors in addition to fluoxetine are still encouraged as first-line interventions. The need for additional assessments, precautions, and monitoring is emphasized, as well as continuation and maintenance treatment. CONCLUSIONS: Evidence and expert clinical consensus support the use of selected antidepressants in the treatment of depression in youths. The use of the recommended antidepressant medications requires appropriate monitoring of suicidality and potential adverse effects and consideration of other evidence-based treatment alternatives such as cognitive behavioral therapies.
OBJECTIVE: To revise and update consensus guidelines for medication treatment algorithms for childhood major depressive disorder based on new scientific evidence and expert clinical consensus when evidence is lacking. METHOD: A consensus conference was held January 13-14, 2005, that included academic clinicians and researchers, practicing clinicians, administrators, consumers, and families. The focus was to review, update, and incorporate the most current data to inform and recommend specific pharmacological approaches and clinical guidance for treatment of major depressive disorder in children and adolescents. RESULTS: Consensually agreed on medication algorithms for major depression (with and without psychosis) and comorbid attention-deficit disorders were updated. These revised algorithms also incorporated approaches to address issues of suicidality, aggression, and irritability. Stages 1, 2, and 3 of the algorithm consist of selective serotonin reuptake inhibitor and norepinephrine serotonin reuptake inhibitor medications whose use is supported by controlled, acute clinical trials and clinical experience. Recent studies provide support that selective serotonin reuptake inhibitors in addition to fluoxetine are still encouraged as first-line interventions. The need for additional assessments, precautions, and monitoring is emphasized, as well as continuation and maintenance treatment. CONCLUSIONS: Evidence and expert clinical consensus support the use of selected antidepressants in the treatment of depression in youths. The use of the recommended antidepressant medications requires appropriate monitoring of suicidality and potential adverse effects and consideration of other evidence-based treatment alternatives such as cognitive behavioral therapies.
Authors: Carroll W Hughes; Madhukar H Trivedi; Joseph Cleaver; Tracy L Greer; Graham J Emslie; Beth Kennard; Shauna Dorman; Tyson Bain; Judy Dubreuil; Conrad Barnes Journal: Ment Health Phys Act Date: 2009-12
Authors: Douglas G Kondo; Young-Hoon Sung; Tracy L Hellem; Kristen K Fiedler; Xianfeng Shi; Eun-Kee Jeong; Perry F Renshaw Journal: J Affect Disord Date: 2011-08-09 Impact factor: 4.839
Authors: Laura P Richardson; Evette Ludman; Elizabeth McCauley; Jeff Lindenbaum; Cindy Larison; Chuan Zhou; Greg Clarke; David Brent; Wayne Katon Journal: JAMA Date: 2014-08-27 Impact factor: 56.272
Authors: John Curry; Susan Silva; Paul Rohde; Golda Ginsburg; Christopher Kratochvil; Anne Simons; Jerry Kirchner; Diane May; Betsy Kennard; Taryn Mayes; Norah Feeny; Anne Marie Albano; Sarah Lavanier; Mark Reinecke; Rachel Jacobs; Emily Becker-Weidman; Elizabeth Weller; Graham Emslie; John Walkup; Elizabeth Kastelic; Barbara Burns; Karen Wells; John March Journal: Arch Gen Psychiatry Date: 2010-11-01
Authors: Graham J Emslie; Beth D Kennard; Taryn L Mayes; Jeanne Nightingale-Teresi; Thomas Carmody; Carroll W Hughes; A John Rush; Rongrong Tao; Jeanne W Rintelmann Journal: Am J Psychiatry Date: 2008-02-15 Impact factor: 18.112