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Bellato A, Sesso G, Milone A, Masi G, Cortese S. Systematic Review and Meta-Analysis: Altered Autonomic Functioning in Youths With Emotional Dysregulation. J Am Acad Child Adolesc Psychiatry 2024; 63:216-230. [PMID: 36841327 DOI: 10.1016/j.jaac.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/20/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To systematically investigate if there is a significant association between markers of autonomic functioning and emotional dysregulation (ED) in children and adolescents. METHOD Based on a preregistered protocol (PROSPERO: CRD42021239635), PubMed, Web of Knowledge/Science, Ovid MEDLINE, Embase, and APA PsycInfo databases were searched until April 21, 2021, to identify empirical studies reporting indices of autonomic nervous system (ANS) functioning in youths meeting DSM (version III, IV, IV-TR, 5 or 5-TR) or International Classification of Diseases (ICD) (version 9 or 10) criteria for any psychopathological/neurodevelopmental condition and assessed for ED with a validated scale. Eligible outcomes included correlation coefficients between ED and ANS measures or differences in ANS measures between youths with and without ED. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS) and the Newcastle-Ottawa Scale (NOS) for cohort studies. Random-effects meta-analyses were used for data synthesis. RESULTS There were 12 studies (1,016 participants) included in the descriptive review and 9 studies (567 participants) included in the meta-analyses. No evidence of a significant association between ED and altered cardiac or electrodermal functioning was found. However, exploratory meta-regressions suggested a possible association between reduced resting-state cardiac vagal control and increased ED. CONCLUSION This study did not find evidence of an association between ED and autonomic dysfunction. However, preliminary evidence that reduced vagal control at rest might be a transdiagnostic marker of ED in young people was found. Additional studies comparing autonomic measures in youths with and without ED are needed and should also assess the effects of interventions for ED on ANS functioning. STUDY PREREGISTRATION INFORMATION Systematic Review and Meta-Analysis: Is Autonomic Nervous System Functioning Atypical in Children and Adolescents With Emotional Dysregulation? https://www.crd.york.ac.uk/prospero/; CRD42021239635.
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Affiliation(s)
- Alessio Bellato
- University of Nottingham Malaysia, Malaysia; King's College London, United Kingdom.
| | - Gianluca Sesso
- IRCCS Stella Maris Foundation, Pisa, Italy; University of Pisa, Italy
| | | | | | - Samuele Cortese
- University of Southampton, United Kingdom; New York University Langone Health, New York
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Pitzer M. The development of monoaminergic neurotransmitter systems in childhood and adolescence. Int J Dev Neurosci 2019; 74:49-55. [PMID: 30738086 DOI: 10.1016/j.ijdevneu.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/18/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022] Open
Abstract
Brain maturation extends throughout adolescence well into early adulthood. Knowledge on developmental changes is crucial for age-appropriate pharmacotherapy. This article reviews data on maturational processes with a focus on the noradrenergic, dopaminergic, and serotonergic neurotransmitter systems.The literature was searched with a focus on studies in humans. However, since data in humans are limited animal studies were also included. All reviewed neurotransmitter systems show age-related development processes that differentiate child and adolescent brain function from those of adult brains. Unfortunately, the state of knowledge surrounding development-related changes remains sufficiently sparse, There is a high need for more studies on pediatric psychopharmacology and its biological underpinnings. Safety and efficacy of psychopharmacological medicines cannot be readily extrapolated from adults.
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Affiliation(s)
- Martina Pitzer
- Department of Child and Adolescent Psychiatry, Vitos Klinik Rheinhöhe, Kloster-Eberbach-Str. 4, 65346 Eltville, Germany.
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Depression and resting state heart rate variability in children and adolescents — A systematic review and meta-analysis. Clin Psychol Rev 2016; 46:136-50. [DOI: 10.1016/j.cpr.2016.04.013] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 04/18/2016] [Accepted: 04/23/2016] [Indexed: 12/13/2022]
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Fisher AJ, Reeves JW, Chi C. Dynamic RSA: Examining parasympathetic regulatory dynamics via vector-autoregressive modeling of time-varying RSA and heart period. Psychophysiology 2016; 53:1093-9. [DOI: 10.1111/psyp.12644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Aaron J. Fisher
- Department of Psychology; University of California, Berkeley; Berkeley California USA
| | - Jonathan W. Reeves
- Department of Psychology; University of California, Berkeley; Berkeley California USA
| | - Cyrus Chi
- Department of Psychology; University of California, Berkeley; Berkeley California USA
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Abstract
Major depression is associated with a 4-fold increased risk for premature death, largely accounted by cardiovascular disease (CVD). The relationship between depression and CVD is thought to be mediated by the so-called metabolic syndrome (MeS). Epidemiological studies have consistently demonstrated a co-occurrence of depression with MeS components, ie, visceral obesity, dyslipidemia, insulin resistance, and hypertension. Although the exact mechanisms linking MeS to depression are unclear, different hypotheses have been put forward. On the one hand, MeS could be the hallmark of the unhealthy lifestyle habits of depressed patients. On the other, MeS and depression might share common alterations of the stress system, including the hypothalamus-pituitary-adrenal (HPA) axis, the autonomic nervous system, the immune system, and platelet and endothelial function. Both the conditions induce a low grade chronic inflammatory state that, in turn, leads to increased oxidative and nitrosative (O&NS) damage of neurons, pancreatic cells, and endothelium. Recently, neurobiological research revealed that peripheral hormones, such as leptin and ghrelin, which are classically involved in homeostatic energy balance, may play a role in mood regulation. Metabolic risk should be routinely assessed in depressed patients and taken into account in therapeutic decisions. Alternative targets should be considered for innovative antidepressant agents, including cytokines and their receptors, intracellular inflammatory mediators, glucocorticoids receptors, O&NS pathways, and peripheral mediators.
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Fisher AJ, Woodward SH. Cardiac stability at differing levels of temporal analysis in panic disorder, post-traumatic stress disorder, and healthy controls. Psychophysiology 2014; 51:80-7. [PMID: 24102634 PMCID: PMC3864565 DOI: 10.1111/psyp.12148] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 07/31/2013] [Indexed: 12/19/2022]
Abstract
The panic disorder (PD) literature provides evidence for both physiologic rigidity and instability as pathognomonic features of this disorder. This ambiguity may be a result of viewing PD at differential levels of temporal analysis. We assessed cardiac variability across three levels of temporal scale in PD patients, post-traumatic stress disorder (PTSD) patients, and healthy controls. Sixteen healthy controls, 14 PD patients, 23 PTSD patients, and 16 PTSD + PD patients presented for a polysomnogram. Differences were assessed in respiratory sinus arrhythmia (RSA), autoregressive stability of heart rate (HR), and the number of nonspecific accelerations in HR over the night. No differences in RSA were found between groups; however, PD patients exhibited significantly lower autoregressive HR stability, and all patients had significantly more HR accelerations than controls. These data reinforce prior findings demonstrating physiologic instability in PD and indicate that prior equivocalities regarding physiologic variability in PD may be due to limited temporal scaling of measurements.
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Affiliation(s)
- Aaron J Fisher
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
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Fisher AJ, Newman MG. Heart rate and autonomic response to stress after experimental induction of worry versus relaxation in healthy, high-worry, and generalized anxiety disorder individuals. Biol Psychol 2013; 93:65-74. [PMID: 23384513 DOI: 10.1016/j.biopsycho.2013.01.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 01/19/2013] [Accepted: 01/19/2013] [Indexed: 01/08/2023]
Abstract
Generalized anxiety disorder (GAD) is the most commonly occurring anxiety disorder and has been related to cardiovascular morbidity such as cardiac ischemia, sudden cardiac death, and myocardial infarction. Both GAD and its cardinal symptom - worry - have been shown to promote muted physiological reactivity in response to laboratory and ecological stressors. Importantly, no study to date has examined the concurrent and relative contributions of trait and state worry within healthy controls, (non-clinical) high trait-worry controls, and GAD participants. The present study examined heart rate (HR), respiratory sinus arrhythmia (RSA), and salivary alpha-amylase (sAA) responses to laboratory stress during and following the experimental induction of worry versus relaxation in healthy controls (n=42), high trait worriers (n=33) and participants with GAD (n=76). All groups exhibited increased HR and decreased RSA in response to the stressor, with no differences by condition. Baseline sAA significantly moderated HR and RSA reactivity, such that higher sAA predicted greater increases in HR and decreases in RSA. There was a significant group by baseline sAA interaction such that in GAD, higher baseline sAA predicted decreased change in sAA during stress, whereas higher baseline sAA predicted greater sAA change in healthy controls. High-worry controls fell non-significantly between these groups. The present study provides additional evidence for the effect of worry on diminished HR stress response and points to possible suppression of adrenergic sympathetic stress responses in GAD.
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Affiliation(s)
- Aaron J Fisher
- Stanford University School of Medicine, Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305, USA.
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Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use. Acta Psychiatr Scand 2010; 122:30-9. [PMID: 20456284 DOI: 10.1111/j.1600-0447.2010.01565.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The metabolic syndrome (MetSyn) predisposes to cardiovascular disease and diabetes mellitus. There might also be an association between the MetSyn and anxiety and depression, but its nature is unclear. We aimed to investigate whether diagnosis, symptom severity and antidepressant use are associated with the MetSyn. METHOD We addressed the odds for the MetSyn and its components among 1217 depressed and/or anxious subjects and 629 controls, and their associations with symptom severity and antidepressant use. RESULTS Symptom severity was positively associated with prevalence of the MetSyn, [adjusted odds ratio (OR) 2.21 for very severe depression: 95% confidence interval (CI): 1.06-4.64, P = 0.04], which could be attributed to abdominal obesity and dyslipidemia. Tricyclic antidepressant (TCA) use also increased odds for the MetSyn (OR 2.30, 95% CI: 1.21-4.36, P = 0.01), independent of depression severity. CONCLUSION The most severely depressed people and TCA users more often have the MetSyn, which is driven by abdominal adiposity and dyslipidemia.
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Dopheide JA. Recognizing and treating depression in children and adolescents. Am J Health Syst Pharm 2006; 63:233-43. [PMID: 16434782 DOI: 10.2146/ajhp050264] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The clinical presentation and neurobiology of depression in youth and its appropriate treatment, as well as strategies for improving therapeutic benefit and preventing adverse outcomes, including suicide, are reviewed. SUMMARY Functionally impairing depression occurs in 2-10% of children and adolescents. A diagnosis of depression should be considered when a physically healthy child exhibits depressed mood or anhedonia, multiple somatic complaints, or behavioral changes, such as bullying, aggression, and social withdrawal. Risk factors for depression include childhood trauma, genetic susceptibility, and environmental stressors. Antidepressants and cognitive behavioral therapy are the most effective treatments for adolescents with depression. Youth are at risk for the same adverse effects as adults but have an increased risk of behavioral activation, or switch, to mania and suicidal thoughts and behaviors early in treatment. Compared with other antidepressants, fluoxetine has the most evidence for safety and efficacy, particularly in adolescents 12 years or older. There is very little evidence for the effectiveness of any antidepressant in children 11 years and younger. Youth receiving antidepressants should be monitored closely for new-onset or worsening suicidality, particularly during the first two weeks after starting medication, and for three months of therapy. Behavioral activation, aggression, worsening depression, anxiety, insomnia, or impulsivity can herald a switch to mania or suicidality. CONCLUSION Depression in youth is common and treatable and responds best to multimodal treatment combining patient and family education, cognitive behavioral therapy, and antidepressant medication. The potential benefits of antidepressants outweigh the risks for adolescents. Family and psychotherapeutic interventions are most effective for prepubertal children.
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Affiliation(s)
- Julie A Dopheide
- Schools of Pharmacy and Medicine, University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90089, USA.
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Dubreuil E, Ditto B, Dionne G, Pihl RO, Tremblay RE, Boivin M, Pérusse D. Familiality of heart rate and cardiac-related autonomic activity in five-month-old twins: The Québec newborn twins study. Psychophysiology 2003; 40:849-62. [PMID: 14986838 DOI: 10.1111/1469-8986.00103] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The familiality of infant sleeping heart rate (HR) and cardiac-related autonomic activity, as indexed by spectral analysis of HR variability (HRV) and response to postural change, was investigated in 322 5-month-old twin pairs. The postural change elicited only minor changes in cardiovascular activity. As a result, analyses focused on supine cardiovascular activity. Multivariate genetic modeling indicated that individual differences in sleeping HR and high frequency (HF) HRV were determined by unique environmental and distinct additive genetic factors. These variables, along with low frequency (LF) HRV, were also affected by overlapping familial environmental influences. Familial influences in HF HRV were more pronounced for baby girls than boys. Estimates of relative LF and HF HRV were determined by common (familial) and unique environmental factors; familial influences on these estimates did not overlap with familial influences on sleeping HR.
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Affiliation(s)
- Etienne Dubreuil
- Research Unit on Children's Psychosocial Maladjustment (GRIP), Université de Montreal, Montréal, Québec, Canada.
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Labellarte MJ, Crosson JE, Riddle MA. The relevance of prolonged QTc measurement to pediatric psychopharmacology. J Am Acad Child Adolesc Psychiatry 2003; 42:642-50. [PMID: 12921471 DOI: 10.1097/01.chi.0000046860.56865.25] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To consider the relevance of prolonged QTc (QT interval corrected for rate) to pediatric psychopharmacology. METHOD The authors reviewed publications on QTc prolongation and publications on sudden death in Medline from 1968 to November 2002. RESULTS The search yielded more than 20,000 publications. Review manuscripts with clinical recommendations outnumber the few pediatric studies of QTc duration during treatment. Most reviews have been published in the past 5 years, during a time when the Food and Drug Administration restricted five psychotropic medications because of QTc prolongation (sertindole: not approved; thioridazine, mesoridazine, and droperidol: black-box warning; and ziprasidone: bolded warning) and nine somatic medications because of QTc prolongation. CONCLUSION Pretreatment screening, careful selection of psychotropic and/or somatic medication combinations, and recognition of QTc prolongation in electrocardiographic tracings during treatment with medications that prolong QTc are important components of clinical practice.
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Affiliation(s)
- Michael J Labellarte
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21287-3325, USA.
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Silke B, Campbell C, King DJ. The potential cardiotoxicity of antipsychotic drugs as assessed by heart rate variability. J Psychopharmacol 2002; 16:355-60. [PMID: 12503835 DOI: 10.1177/026988110201600410] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most antipsychotic drugs have cardiac effects as a consequence of their pharmacological actions. Recently, thioridazine has been subjected to a restricted indications notice and sertindole had its license withdrawn because of concerns about their potential cardiotoxicity. In the development of new atypical agents, heart-rate corrected QT effects are evaluated but it is unclear how predictive these are of clinically significant cardiotoxicity or sudden death. Heart rate variability (HRV) is a potential index of cardiotoxicity which has been found to be decreased following antidepressants and clozapine. We studied acute HRV changes following antipsychotic agents. Sixteen healthy male volunteers received risperidone (4 mg), olanzapine (10 mg), thioridazine (50 mg) or placebo in a randomized cross-over design. Subjective effects and psychomotor function were assayed at 2 h and both linear (summary statistics) and non-linear (scatterplot) measures of HRV were evaluated by continuous electrocardiogram recording over 10 h. Differential effects of single doses of the three antipsychotic drugs on HRV were found, and these were independent of their sedative effects. Olanzapine increased, and thioridazine decreased HRV, while risperidone had no effect. HRV is sensitive to the acute effects of antipsychotics. It may prove to be a reliable index of their potential for cardiotoxicity. Further studies in both healthy volunteers and patients on antipsychotic medication will be valuable.
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Affiliation(s)
- B Silke
- Department of Therapeutics and Pharmacology, The Queen's University of Belfast, Whitla Medical Building, Belfast, UK
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Yeragani VK, Pesce V, Jayaraman A, Roose S. Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures. Biol Psychiatry 2002; 52:418-29. [PMID: 12242058 DOI: 10.1016/s0006-3223(02)01394-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies have linked depression to sudden death and serious cardiovascular events in patients with preexisting cardiac illness. Recent studies have shown decreased vagal function in cardiac patients with depression and depressed patients without cardiac illness. METHODS We compared 20-hour, sleeping, and awake heart period variability measures using spectral analysis, fractal dimension, and symbolic dynamics in two patient groups with major depression and ischemic heart disease (mean age 59-60 years) before and after 6 weeks of paroxetine or nortriptyline treatment. RESULTS Spectral measures showed decreases in awake and sleeping total power (TP: 0.0-0.5 Hz), ultra low frequency power (ULF: 0-0.0033 Hz), very low frequency power (VLF: 0.0033-0.04 Hz), and low-frequency power (LF: 0.04-0.15 Hz) for nortriptyline condition and a decrease in high-frequency power (HF: 0.15-0.5 Hz) for the awake condition in patients who received nortriptyline. A measure of nonlinear complexity, WC-100, significantly increased after paroxetine during the awake condition. CONCLUSIONS These findings suggest that nortriptyline has stronger vagolytic effects on cardiac autonomic function compared with paroxetine, which is in agreement with previous clinical and preclinical reports. Paroxetine may have some cardio-protective effects, especially in cardiac patients.
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Affiliation(s)
- Vikram K Yeragani
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
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McClure EB, Kubiszyn T, Kaslow NJ. Advances in the diagnosis and treatment of childhood disorders. ACTA ACUST UNITED AC 2002. [DOI: 10.1037/0735-7028.33.2.125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dopheide JA. Management of Depression in Children and Adolescents. J Pharm Pract 2001. [DOI: 10.1177/089719001129040982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is increasingly recognized as an illness that causes functional impairment and diminished quality of life for all age groups, including children. One to two percent of children and between 4% and 8% of adolescents meet Diagnostic Statistical Manual of Mental Disorders(4th ed.) (DSM-IV-TR) criteria for major depression. Psychotherapy, particularly cognitive-behavioral therapy, is effective, with 70% response rates. Antidepressants are effective according to limited controlled trials; however, concern exists over the gap between research and clinical practice, as most antidepressants are not well-studied in youth. Nevertheless, pharmacotherapy has gained greater acceptance in pediatric psychiatry, and prescriptions for antidepressants in youth have increased dramatically over the past 5 to 10 years. In 1995, 1.08 million selective serotonin reuptake inhibitor prescriptions were written for children and adolescents. Scientific evidence for the safety and effectiveness of antidepressants in youth is reviewed along with data on nondrug interventions such as cognitive-behavioral therapy. Recommendations for promoting the safe and effective management of depression in children and adolescents is provided.
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Affiliation(s)
- Julie A. Dopheide
- University of Southern California Schools of Pharmacy and Medicine, 1985 Zonal Avenue, Los Angeles, CA 90089
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Beauchaine TP, Gartner J, Hagen B. Comorbid depression and heart rate variability as predictors of aggressive and hyperactive symptom responsiveness during inpatient treatment of conduct-disordered, ADHD boys. Aggress Behav 2001. [DOI: 10.1002/1098-2337(200011)26:6<425::aid-ab2>3.0.co;2-i] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Walsh BT, Greenhill LL, Giardina EG, Bigger JT, Waslick BD, Sloan RP, Bilich K, Wolk S, Bagiella E. Effects of desipramine on autonomic input to the heart. J Am Acad Child Adolesc Psychiatry 1999; 38:1186-92. [PMID: 10504819 DOI: 10.1097/00004583-199909000-00025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of age on the effects of desipramine (DMI) on autonomic input to the heart. METHOD Twenty-four-hour electrocardiograms were obtained from 42 subjects, aged 7 to 66 years, while off and on DMI. To obtain measures of autonomic input to the heart, heart rate variability was assessed via spectral analysis of RR interval variability. RESULTS DMI treatment was associated with a significant increase in 24-hour mean heart rate and significant decreases in RR interval variability in all spectral bands, including in the high-frequency band, which provides a measure of parasympathetic input to the heart. RR interval variability was greater in younger individuals both off and on DMI. CONCLUSIONS DMI treatment was associated with a marked decline in RR interval variability, indicating that DMI affects autonomic input to the heart. Specifically, DMI reduced parasympathetic input, which, in theory, may increase vulnerability to arrhythmias. However, the magnitude of DMI's impact on RR interval variability did not vary with age.
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Affiliation(s)
- B T Walsh
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA.
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Geller B, Reising D, Leonard HL, Riddle MA, Walsh BT. Critical review of tricyclic antidepressant use in children and adolescents. J Am Acad Child Adolesc Psychiatry 1999; 38:513-6. [PMID: 10230182 DOI: 10.1097/00004583-199905000-00012] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide a critical review of the role of tricyclic antidepressant (TCA) medications in children and adolescents. METHOD Multiple resources including a Medline search (1966-1998) were used. RESULTS There were few double-blind, placebo-controlled studies of TCAs, and even fewer with positive results. Also, potentially serious cardiovascular side effects have been described. CONCLUSIONS The future therapeutic role of TCAs for children and adolescents needs to be seriously weighed against lethality of overdose, the unresolved issue of possible sudden unexplained death, and the availability of safer and easier to monitor medications. Ongoing future research on heart rate variability and epidemiology of psychotropic medication-related deaths will address developmental aspects of TCA use.
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Affiliation(s)
- B Geller
- Washington University School of Medicine, St. Louis, MO 63110, USA
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Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. AACAP. J Am Acad Child Adolesc Psychiatry 1998; 37:63S-83S. [PMID: 9785729 DOI: 10.1097/00004583-199810001-00005] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Child and adolescent major depressive disorder and dysthymic disorder are common, chronic, familial, and recurrent conditions that usually persist into adulthood. These disorders appear to be manifesting at an earlier age in successive cohorts and are usually accompanied by comorbid psychiatric disorders, increased risk for suicide, substance abuse, and behavior problems. In addition, depressed youth frequently have poor psychosocial, academic, and family functioning, which highlights the importance of early identification and prompt treatment. Both psychotherapy and pharmacotherapy have been found to be beneficial for the acute treatment of youth with depressive disorders. Opinions vary regarding which of these treatments should be offered first and whether they should be offered in combination. In general, the choice of initial therapy depends on clinical and psychosocial factors and therapist's expertise. Based on the current literature and clinical experience, psychotherapy may be the first treatment for most depressed youth. However, antidepressants must be considered for those patients with psychosis, bipolar depression, severe depressions, and those who do not respond to an adequate trial of psychotherapy. All patients need continuation therapy and some patients may require maintenance treatment. Further research is needed on the etiology of depression; the efficacy of different types of psychotherapy; the differential effects of psychotherapy, pharmacotherapy, and integrated therapies; the continuation and maintenance treatment phases; treatment for dysthymia, treatment-resistant depression, and other subtypes of major depressive disorder; and preventive strategies for high-risk children and adolescents.
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