ABSTRACT
In recent years, the selective serotonin-reuptake inhibitors (SSRIs) and newer novel antidepressants have become the first-line antidepressants used by most clinicians for adults because of their established efficacy, relatively benign side effects, and ease of administration (see Chapter 9). Tricyclic antidepressants (TCAs) are no longer considered first-line treatment despite their established efficacy in adults with major depressive disorder (MDD) (Glassman and Roose, 1990). While child and adolescent MDD appears to exhibit comparable SSRI responsivity as adult MDD, there is no conclusive evidence that TCAs are superior to placebo in pediatric MDD (Ryan and Varma, 1998). In fact, noradrenergic and mixed noradrenergic/serotonergic TCAs do not appear to be effective at all in pediatric MDD. Nonetheless, investigation has revealed other potential roles for TCAs in the treatment of child and adolescent conditions, a topic that will be discussed in this chapter. We will also explore the present status of psychopharmacology in child and adolescent major depression and suggest possible future directions. The reader is also referred to the excellent and comprehensive review on TCA use in children and adolescents by Geller and colleagues (1999).
