SERTRALINE FOR MAJOR DEPRESSION IN CHILDREN AND ADOLESCENTS - PRELIMINARY CLINICAL-EXPERIENCE

Objective: To evaluate the therapeutic and adverse effects of sertrali ne in children and adolescents with major depressive disorder (MDD). M ethod: Retrospective chart reviews were conducted on 33 youths (ages 8 -18 years) treated for MDD with sertraline and no other psychotropic m edication. Focusing on the interval from 2 to 10 weeks of treatment (w hen therapeutic changes were anticipated), clinical changes were asses sed utilizing the Clinical Global Impression (CGI) subscales for sever ity of illness (modified to reflect severity of depressive illness) in 21 patients and for global improvement in 17 patients. Adverse effect s were assessed in all 33 patients. Results: By the tenth week of trea tment, the mean scores for severity of depressive illness changed sign ificantly from 5.8 to 3.4 (6 = severely ill, 3 = mildly ill) and globa l improvement scores indicated that 11 of 17 patients (65%) improved m uch or very much. Older children improved to a greater degree. Mean do se was 1.6 mg/kg or 100 mg (range 25-200 mg) daily. No data were colle cted on which symptoms may have responded. Adverse effects were experi enced by 16 of 33 patients, and 8 discontinued sertraline due to adver se effects. Seven patients (21%), including 4 of the 8 discontinuers, experienced behavioral side effects, whose onset clustered within the first 2 weeks and at 3 months of treatment. Two patients developed man ia during sertraline treatment (one at 3 days, other at 94 days), and five developed other types of behavioral activation. No patient showed a worsening of depressive symptoms or an onset of suicidality or viol ence. Fatigue and sedation appeared to resolve spontaneously. Conclusi on: These preliminary and uncontrolled clinical findings suggest that some children and adolescents with MDD may respond to sertraline, but adverse behavioral effects may be common.