Texas Children’s Medication Algorithm Project: Update From Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder - 11/08/11
, GRAHAM J. EMSLIE, M.D., M. LYNN CRISMON, Pharm.D., KELLY POSNER, Ph.D., BORIS BIRMAHER, M.D., NEAL RYAN, M.D., PETER JENSEN, M.D., JOHN CURRY, Ph.D., BENEDETTO VITIELLO, M.D., MOLLY LOPEZ, Ph.D., STEVE P. SHON, M.D., STEVEN R. PLISZKA, M.D., MADHUKAR H. TRIVEDI, M.D.THE TEXAS CONSENSUS CONFERENCE PANEL ON MEDICATION TREATMENT OF CHILDHOOD MAJOR DEPRESSIVE DISORDER
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.
Le texte complet de cet article est disponible en PDF.Key Words : medication algorithm, major depressive disorder, suicidality, childhood psychopharmacology, child and adolescent depression
Plan
| The Texas Consensus Conference Panel is coordinated and funded by the Texas Department of State Health Services. No pharmaceutical company provided support or was in any way involved with this consensus conference. The Texas Department of State Health Services, the Department of Psychiatry, University of Texas Southwestern Medical Center, and the University of Texas at Austin College of Pharmacy receive funding from the Texas State Legislature. The opinions and assertions contained in this report are the private views of the authors and are not to be construed as official or as reflecting the views of the National Institute of Mental Health, the National Institutes of Health, or the U.S. Department of Health and Human Services. The members of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder are as follows: Graham J. Emslie, M.D. (chair), Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; M. Lynn Crismon, Pharm.D. (co-chair), College of Pharmacy, University of Texas at Austin; Joan Barcelona, Ft. Worth; Boris Birmaher, M.D., Western Psychiatric Institute and Clinic, Pittsburgh; John Curry, Ph.D., Duke University, Durham, NC; Cindy Hopkins, family member, Texas Department of State Health Services, Austin; Carroll W. Hughes, Ph.D., Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Peter S. Jensen, M.D., Center for the Advancement of Children’s Mental Health, Department of Psychiatry, Columbia University and Office of Mental Health, New York; Molly Lopez, Ph.D., Texas Department of State Health Services, Austin; Robin Mallett, M.D., Gulf Coast MHMR Center, League City, TX; Sylvia Musquiz, M.D., Mental Health and Mental Retardation Authority of Harris County, Houston; Steven R. Pliszka, M.D., Department of Psychiatry, University of Texas Health Science Center at San Antonio; Kelly Posner, Ph.D., Columbia University, New York; Valerie Robinson, M.D., Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock; Susan Rogers, family member, Dallas; Neal Ryan, M.D., Western Psychiatric Institute and Clinic, Pittsburgh; Steve Shon, M.D., Texas Department of State Health Services, Austin; Madhukar Trivedi, M.D., Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Sylvia Turner, M.D., Child and Adolescent Unit, Terrell State Hospital, Terrell, TX; Benedetto Vitiello, M.D., National Institute of Mental Health, Bethesda, MD. Disclosure: Dr. Hughes has received recent research support from GlaxoSmithKline (GSK) and is a consultant to Biobehavioral Diagnostics, Inc. Dr. Emslie receives research support from Eli Lilly, Organon, Inc., and Forest Laboratories; is a consultant to Biobehavioral Diagnostics Inc., Eli Lilly, GSK, Forest, Wyeth-Ayerst, and Pfizer; and is on the speakers’ bureau of McNeil Consumer and Specialty Pharmaceuticals. During the past 3 years Dr. Crismon has received research support from, served as a consultant to, or has been on the speakers’ bureaus of the following: Bristol-Myers Squibb (BMS), Corcept Therapeutics, Cyberonics, Inc., Eli Lilly, Jackson Evidence Based Partnership, Janssen Pharmaceutica, McNeil Specialty and Consumer Products, Pfizer, Seton Health Network, and Shire Pharmaceuticals. As part of an effort to help execute the FDA suicidality classification mandates, Dr. Posner has received research support from GSK, Forest, Eisai, AZ Pharmaceuticals, Johnson & Johnson, Abbott Laboratories, Wyeth-Ayerst Research, Organon USA, BMS, Sanofi-Aventis, Cephalon, Novartis, Shire Pharmaceuticals, and UCB Pharma. Dr. Ryan has served as a consultant to Pfizer, GSK, BMS, Lilly, Wyeth-Ayerst, Abbott, and Janssen and has received grant funding from GSK and Wyeth-Ayerst. Dr. Jensen receives investigator-initiated grants from McNeil and unrestricted educational grants from Pfizer, Eli Lilly, and McNeil; participates in the speakers’ bureaus of CMED, UCB, PsychCME, CME Outfitters, and the Neuroscience Education Institute; and consults with Best Practice, Inc., Janssen, Novartis, and UCB. Dr. Pliszka serves as a consultant to and a member of the speakers’ bureaus of Shire and McNeil Specialty and Consumer Products; he has received research support from Eli Lilly, Cephalon, and AZ. Dr. Trivedi has received research support from, served as a consultant to, or been on the speakers’ bureaus of Abdi Brahim, Abbott, Akzo (Organon Pharmaceuticals), AstraZeneca, Bayer, BMS, Cephalon, Corcept Therapeutics, Cyberonics, Eli Lilly, Forest, GSK, Janssen, Johnson & Johnson, Meade Johnson, Merck, Neuronetics, Novartis, Parke-Davis Pharmaceuticals, Pfizer, Pharmacia & Upjohn, Predix Pharmaceuticals, Sepracor, Solvay Pharmaceuticals, and Wyeth-Ayerst. The other authors have no financial relationships to disclose. |
Vol 46 - N° 6
P. 667-686 - juin 2007 Retour au numéro
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