Locher2017
Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and
Placebo for Common Psychiatric Disorders among Children and Adolescents
A Systematic Review and Meta-analysis
Thirty-six trials were eligible, including 6778 participants (3484 [51.4%] female; mean [SD] age, 12.9 [5.1] years); 17
studies for DD, 10 for AD, 8 for OCD, and 1 for PTSD. Analysis showed that SSRIs and SNRIs were significantly more
beneficial compared with placebo, yielding a small effect size (g = 0.32; 95%CI, 0.25-0.40; P < .001). Anxiety disorder (g =
0.56; 95%CI, 0.40-0.72; P < .001) showed significantly larger between-group effect sizes than DD (g = 0.20; 95%CI, 0.130.27; P < .001). This difference was driven primarily by the placebo response: patients with DD exhibited significantly
larger placebo responses (g = 1.57; 95%CI, 1.36-1.78; P < .001) compared with those with AD (g = 1.03; 95%CI, 0.84-1.21;
P < .001). The SSRIs produced a relatively large effect size for ADs (g = 0.71; 95% CI, 0.45-0.97; P < .001). Compared with
participants receiving placebo, patients receiving an antidepressant reported significantly more treatment-emergent
adverse events (RR, 1.07; 95%CI, 1.01-1.12; P = .01 or RR, 1.49; 95%CI, 1.22-1.82; P < .001, depending on the reporting
Method), severe adverse events (RR, 1.76; 95%CI, 1.34-2.32; P < .001), and study discontinuation due to adverse events
(RR, 1.79; 95%CI, 1.38-2.32; P < .001).
Management of Treatment-Resistant Depression in Children
and Adolescents. De Fillipis 2014
Desde el estudio TORDIA 12–17 años (N= 334) (Treatment of SSRI-Resistant Depression in
Adolescents), Fluoxetina, Setralina, Citalopram y Escitalopram 1era line
Youth treated with venlafaxine had a higher incidence of increased diastolic blood pressure and pulse and skin problems
than youth treated with an alternate SSRI citalopram dosing of 40 mg/day or less due to the risk of QT interval
prolongation on ECG
Quetiapina 200mg , 10 adolescentes (13-18 años) respondieron 7, aumento de peso y sedación EAdv mas frecuentes
[Management of child and adolescent depression in
primary care: A systematic meta-review]
Thirty-eight studies were included: 12 recommendations, 5 systematic reviews and 21 meta-analyses. The best
evaluated guideline had an AGREE-II assessment of 81%, and the best evaluated meta-analysis had an assessment of
86% for R-AMSTAR and 96% for PRISMA. The average scores of the R-AMSTAR and PRISMA assessments were 65% and
72% respectively. The average score of the AGREE II grid assessment was 57%. The data were synthesized into a
practical guide for the GPs' practice, corresponding to the different consultation times. MDD diagnosis should be done
on the DSM or ICD basis. The Childrens' Depression Rating Scale-revised or the Revised Beck Depression Inventory are
useful in primary care for MDD appraisal in children and adolescents. For mild MDD a supportive psychotherapy and
surveillance for 4 to 6 weeks is preconized in primary care. In the absence of improvement, a specific and structured
psychotherapy is recommended, and the patient should be addressed to a child psychiatrist. For moderate to severe
MDD, the young patient should be addressed to a specialist in child psychiatry. A psychotherapy, which can be
associated with fluoxetine, especially in adolescents, is indicated with a revaluation of the pharmacological treatment
between 4 to 8 weeks. A weekly follow-up by the GP is recommended during the first month, especially after the
initiation of an antidepressant to assess the suicidal risk. Beyond the first month, a consultation should be scheduled
every two weeks.
Intravenous Ketamine for Adolescents with Treatment-Resistant Depression: An
Open-Label Study, by Cullen KR, Amatya P, Roback MG, Albott CS, Westlund
Schreiner M, Ren Y, Eberly LE, Carstedt P, Samikoglu A, Gunlicks-Stoessel M,
Reigstad K, Horek N, Tye S, Lim KO, Klimes-Dougan B. J Child Adolesc
Psychopharmacol 2018;28(7):437–444. DOI: 10.1089/cap.2018.0030
Adjunctive Sleep Medications and Depression Outcome
in the Treatment of Serotonin-Selective Reuptake
Inhibitor Resistant Depression in Adolescents Study
334 Adolescentes que recibieron tto en tiempo y dosis suficiente de
fluoxetina, citalopram o venlafaxina + CBT, recibieron higiene del
sueño.
-
Recibieron Trazodona, Difenhidramina, Zolpidem y Eszopiclona
-
El studio señala que la trazodona es el medicamento mayormente indicado
REsultado: Trazodona empeoró el resultado de la depresion en relación con lesions autoinflinjidas y efectos
adversos como priaprismo, el resto mantuvo igual su correlato a los pacientes que no recibieron medicación
para dormer
Treatment-Resistant Depression in an Adolescent
Treated with Clozapine:
Weighing the Options in a Young Suicidal Patient
Axis I: Major depressive disorder severe, recurrent without
psychotic features
Generalized anxiety disorder
History of PTSD
Rule out depression induced by another medical condition:
migraine/chronic pain
Axis II: BPD features
Axis III: Migraine headaches
Asthma
Allergies: dust, nuts, peanuts, and penicillin
Axis IV: Problems related to social environment: separation of
parents, and poor social support with limited family support.
Axis V: 10 on admission; 20 on last evaluation
Paciente de 13 años internado por ideación de muerte y planifiacion, 2 suicidios frustros intrainteracion, factores de riesgo: PTSD , separación de
padres, maltrato parental,
Tratamiento; Escitalopram + Clozapina
Remisión de suicidabilidad , ideas de muerte y planificación, sin efectso adversos graves como agranulocitosis, miocarditis y paciente negó
incidencia de hipersalivación, aumento de peso, constipación, sedación
Depresión y Trauma
Depression in Maltreated
Children and Adolescents
Michael D. De Bellis, MD, MPHa,*, Kate B. Nooner, PhDb,
Jeanette M. Scheid, MD, PhDc, Judith A. Cohen, MDd
Evidencia Grado B: 29 RCT demostraron Risperidona, Litio, y luego Valproato con alto NNT
1era línea Risperidona
2da línea Combinación con Litio o Monoterapia
3era Linea Valproato
Depression in Maltreated
Children and Adolescents
Michael D. De Bellis, MD, MPHa,*, Kate B. Nooner, PhDb,
Jeanette M. Scheid, MD, PhDc, Judith A. Cohen, MDd
Comparative efficacy and acceptability of antidepressants,
psychotherapies, and their combination for acute
treatment
of children and adolescents with depressive disorder:
a systematic review and network meta-analysis.
71 trials (9510 participants )