ABSTRACT
The selective serotonin-reuptake inhibitors (SSRIs) have become drugs of first choice for many psychiatric conditions including major depressive disorder (MDD), obsessive-compulsive disorder (OCD), bulimia, panic and other anxiety disorders, among others. SSRIs appear to be comparable in efficacy to the tricyclic antidepressants (TCAs) in adults but have fewer side effects, are far less lethal in overdose, and are likely to have more clinical indications (Emslie et al., 1999). Moreover, recent investigation has suggested the efficacy of the SSRIs, fluoxetine (Emslie et al., 1997, 2000), and paroxetine (Keller et al., 2001) in child and adolescent MDD, whereas the TCAs have consistently demonstrated no superiority over placebo in pediatric MDD (see Chapter 8). Brophy (1995) reported over 200,000 prescriptions and refills of fluoxetine and sertraline for children 5-10 years of age in 1994, representing a fourfold increase in a 2-year period. Increased use of SSRIs and other psychotropic agents, particularly the psychostimulants, in younger children has resulted in additional investigation into prescribing practices (Zito et al., 2000) and questions as to whether these medications have been overprescribed. While investigation to date raises many more questions than are answered, i.e, who is prescribing the medications, conditions being treated, etc, there is no question that these medications are being prescribed with a minimum
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of extant controlled research study (Emslie et al., 1999). While this chapter underscores the growing need for additional research investigation to better delineate the clinical efficacy vs. toxicity of the SSRIs as well as many other psychotropic medications in children, we have attempted to synthesize the limited available data to propose ‘‘best resolution’’ of current scientific insights into best clinical judgment and practice.
