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Suizidalität bei depressiven Kindern und Jugendlichen unter Behandlung mit selektiven Serotoninwiederaufnahmehemmern

Review und Metaanalyse verfügbarer plazebokontrollierter Doppelblindstudien

Suicidality in depressive children and adolescents during treatment with selective serotonin reuptake inhibitors

Review and meta-analysis of the available randomised, placebo controlled trials

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Zusammenfassung

Wegen des Verdachts, dass selektive Serotoninwiederaufnahmehemmer (SSRI) bei depressiven Kindern und Jugendlichen vermehrt zu Suizidgedanken und -versuchen führen könnten, wird der Einsatz dieser Substanzen kontrovers debattiert. Alle derzeit publizierten oder anderweitig verfügbaren randomisierten kontrollierten Studien zur Behandlung von Depression bei Kindern und Jugendlichen mit SSRI wurden auf Angaben zur Effektivität sowie Suizidalität untersucht. Die Ergebnisse sprechen für die Effektivität der Depressionsbehandlung mit Fluoxetin sowie mit Einschränkungen für Sertralin. In einer Metaanalyse fanden sich keine statistisch signifikanten Zusammenhänge zwischen der Behandlung mit SSRI und dem Auftreten suizidalen Verhaltens. Nach evidenzbasierten Kriterien ist das Nutzen-Risiko-Verhältnis günstig für Fluoxetin und, mit Einschränkungen, Sertralin und ihr Einsatz in der Pharmakotherapie depressiver Kinder und Jugendlicher indiziert.

Summary

Due to concerns that selective serotonin reuptake inhibitors (SSRI) might be associated with an increased risk of suicidal ideation and suicide attempts in depressive children and adolescents, treatment with these drugs is controversial. All available data from randomised controlled trials on SSRIs treating depression in these age groups were examined regarding efficacy and suicidality. Results suggest that fluoxetine and, less clearly, sertraline are effective in such treatment. A meta-analysis yielded no statistically significant difference between treatment with SSRI and placebo with regard to the occurrence of suicidal behavior. Following evidence-based criteria, the risk:benefit ratio is favourable for fluoxetine and sertraline. Their use in the pharmacotherapy of depressive children and adolescents is indicated.

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Literatur

  1. Andrews JA, Lewinsohn PM (1992) Suicidal attempts among older adolescents: prevalence and co-occurrence with psychiatric disorders. J Am Acad Child Adolesc Psychiatry 31:655–662

    CAS  PubMed  Google Scholar 

  2. Arzneimittelkommission der deutschen Ärzteschaft (2004) SSRI und Suizidalität? Dtsch Arztebl 101:A2642 [Heft 39]. Langfassung verfügbar unter: http://www.aerzteblatt.de/plus3904

  3. Benkert O, Hippius H (2003) Kompendium der Psychiatrischen Pharmakotherapie, 4. Aufl. Springer, Berlin Heidelberg New York

  4. Brent DA, Birmaher B (2004) British warnings on SSRI questioned. J Am Acad Child Adolesc Psychiatry 43:379–380

    Article  PubMed  Google Scholar 

  5. Costello EJ, Angold A, Burns BJ et al. (1996) The great smoky mountains study of youth. Goals, design, methods, and the prevalence of DSM-III-R disorders. Arch Gen Psychiatry 53:1129–1136

    CAS  PubMed  Google Scholar 

  6. CSM (2004) Selective Serotonin Reuptake Inhibitors (SSRIs)—overview of regulatory status and CSM advice relating to major depressive disorder (MDD) in children and adolescents: summary of clinical trials. Verfügbar unter: http://www.mca.gov.uk/ourwork/monitorsafequalmed/safetymessages/ssrioverview_101203.htm. Zugriff am 15. April 2005

  7. DGKJP (2003) Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter. Deutscher Ärzte Verlag, Köln

  8. Fegert JM, Herpertz-Dahlmann B (2004) Zur Problematik der Gabe von Selektiven Serotoninwiederaufnahmehemmern (SSRI) bei depressiven Kindern und Jugendlichen. Nervenarzt 75:908–910

    CAS  PubMed  Google Scholar 

  9. Emslie GJ, Heiligenstein JH, Wagner KD et al. (2002) Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry 41:1205–1215

    Article  PubMed  Google Scholar 

  10. Emslie GJ, Rush AJ, Weinberg WA et al. (1997) A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry 54:1031–1037

    CAS  PubMed  Google Scholar 

  11. FDA (2004) Review and evaluation of clinical data. Verfügbar unter: http://www.fda.gov/ohrms/dockets/ac/04/briefing/2004-4065b1-10-TAB08-Hammads-Review.pdf. Zugriff am 15. April 2005

  12. Fergusson DM, Lynskey MT (1995) Childhood circumstances, adolescent adjustment, and suicide attempts in a New Zealand birth cohort. J Am Acad Child Adolesc Psychiatry 34:612–622

    Article  CAS  PubMed  Google Scholar 

  13. Fleiss JL (1981) Statistical methods for rates and proportions. Wiley, New York

  14. Goodwin FK, Fireman B, Simon GE et al. (2003) Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA 290:1467–1473

    Article  CAS  PubMed  Google Scholar 

  15. Hazell P, O’Connell D, Heathcote D et al. (2003) Tricyclic drugs for depression in children and adolescents. The Cochrane Library, Issue 3

  16. Holtmann M, Bölte S, Wöckel L et al. (2005) Antidepressive Therapie bei Kindern und Jugendlichen: Anwendung und Stellenwert der Selektiven Serotonin-Wiederaufnahmehemmer. Dtsch Arztebl 102:976–978

    Google Scholar 

  17. Isacsson G, Holmgren P, Ahlner J (2005) Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14,857 suicides. Acta Psychiatr Scand 111:286–290

    Article  CAS  PubMed  Google Scholar 

  18. Jobson KO, Potter WZ (1995) International Psychopharmacology Algorithm Project Report. Psychopharmacol Bull 31:457–507

    CAS  PubMed  Google Scholar 

  19. Keller MB, Ryan ND, Strober M et al. (2001) Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 40:762–772

    Google Scholar 

  20. Kenny DA (1999) Meta-Analysis. Version II. University of Connecticut

  21. King RA, Riddle MA, Chappell PB et al. (1991) Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment. J Am Acad Child Adolesc Psychiatry 30:179–186

    CAS  PubMed  Google Scholar 

  22. Mandoki MW, Tapia MR, Tapia MA et al. (1997) Venlafaxine in the treatment of children and adolescents with major depression. Psychopharmacol Bull 33:149–154

    CAS  PubMed  Google Scholar 

  23. March J, Silva S, Petrycki S et al. (2004) Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: treatment for adolescents with depression study (TADS) randomized controlled trial. JAMA 292:807–820

    Article  CAS  PubMed  Google Scholar 

  24. Martinez C, Rietbrock S, Wise L et al. (2005) Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study. BMJ 330:389–395

    Article  CAS  PubMed  Google Scholar 

  25. Myers K, McCauley E, Calderon R et al. (1991) Risks for suicidality in major depressive disorder. J Am Acad Child Adolesc Psychiatry 30:86–94

    CAS  PubMed  Google Scholar 

  26. Olfson M, Shaffer D, Marcus SC et al. (2003) Relationship between antidepressant medication treatment and suicide in adolescents. Arch Gen Psychiatry 60:978–982

    Article  PubMed  Google Scholar 

  27. Simeon JG, Dinicola VF, Ferguson HB et al. (1990) Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up. Prog Neuropsychopharmacol Biol Psychiatry 14:791–795

    Article  CAS  PubMed  Google Scholar 

  28. Vitiello B, Swedo S (2004) Antidepressant medications in children. N Engl J Med 350:1489–1491

    Article  CAS  PubMed  Google Scholar 

  29. Wagner KD, Ambrosini P, Rynn M et al. (2003) Sertraline Pediatric Depression Study Group. Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder: two randomized controlled trials. JAMA 290:1033–1041

    Article  CAS  PubMed  Google Scholar 

  30. Whittington CJ, Kendall T, Fonagy P et al. (2004) Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 363:1341–1345

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main

    M. Holtmann, S. Bölte & F. Poustka

  2. Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Klinikum der Johann-Wolfgang-Goethe-Universität, Deutschordenstraße 50, 60528, Frankfurt, Deutschland

    M. Holtmann

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  1. M. Holtmann
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  2. S. Bölte
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  3. F. Poustka
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Correspondence to M. Holtmann.

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Holtmann, M., Bölte, S. & Poustka, F. Suizidalität bei depressiven Kindern und Jugendlichen unter Behandlung mit selektiven Serotoninwiederaufnahmehemmern. Nervenarzt 77, 1332–1337 (2006). https://doi.org/10.1007/s00115-005-1952-3

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