PHARMACOLOGY OF THE SELECTIVE SEROTONIN REUPTAKE INHIBITORS IN CHILDREN AND ADOLESCENTS

Objective: To review the pharmacology of a new class of medications, t he potent selective serotonin reuptake inhibitors (SSRIs), what is kno wn about their metabolism in children and adolescents, and the practic al clinical implications of such. Method: Articles were retrieved thro ugh Index Medicus searches for articles published during the past 10 y ears on the SSRIs and on pediatric pharmacology. Results: More than 30 0 articles were reviewed. Pharmacological data, derived from relevant adult literature, were summarized and extrapolated to children and fro m the limited pediatric literature. The SSRIs represent a new class of antidepressants with distinct advantages in their side effect profile and their broad therapeutic index over that seen with the tricyclic a ntidepressants. Their advantage of few anticholinergic side effects an d limited cardiovascular toxicities are particularly relevant for the pediatric population. The SSRIs are metabolized via the hepatic cytoch rome isoenzyme P450 system, and potential drug-drug interactions are r eviewed. Conclusions: The SSRIs appear to offer advantages over the tr icyclic antidepressants. Unfortunately, pharmacokinetic data are lacki ng, and systematic studies of safety and efficacy in the pediatric age group are limited. Preliminary reports are encouraging, but further s tudy is required.