A risk-benefit assessment of pharmacotherapies for clinical depression in children and adolescents

Child and adolescent major depressive disorders are common and recurrent di sorders, The prevalence of major depressive disorders is estimated to be ap proximately 2% in children and 4 to 8% in adolescents. Major depressive dis orders in children are frequently accompanied by other psychiatric disorder s, poor psychosocial outcome and a high risk of suicide and substance abuse , indicating the need for effective treatment and prevention. The use of antidepressant medications as the first line of treatment for ch ildren and adolescents with mild to moderate major depressive disorders has been questioned, However, some subgroups of patients, may benefit from ini tial treatment with antidepressants. These subgroups may include patients w ho are unwilling or unable to undergo psychotherapy have not responded to a t least 8 to 12 sessions of psychotherapy, have bipolar, atypical or severe depression or have recurrent depression, Currently, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inh ibitors are the first medication choice because of their efficacy, benign a dverse effect profile, ease of use and low risk of death following an overd ose. Further research in continuation and maintenance treatments, treatment of c omorbid conditions, subtypes of depression, e.g, bipolar, atypical, seasona l, and combinations of pharmacotherapy and psychotherapy are needed. In add ition, studies of the pharmacokinetics, pharmacodynamics and long term adve rse effects of antidepressant medications in children and adolescents are w arranted.