Pine Daniel S
National Institute of Mental Health, Intramural Research Program, Bethesda, Maryland 20892-1381, USA.
J Child Adolesc Psychopharmacol. 2002 Fall;12(3):189-203. doi: 10.1089/104454602760386888.
This article addresses a key question on the use of selective serotonin reuptake inhibitors (SSRIs) among children and adolescents. As briefly reviewed, recent randomized controlled trials have established the safety and efficacy of SSRIs in the acute treatment of major depression and anxiety disorders among children and adolescents. Major questions emerge in light of these data concerning the potential risks and benefits of long-term SSRI use among children and adolescents who receive significant short-term benefits from SSRI treatment. The current review summarizes research on longitudinal outcomes, neuroscience, and psychopharmacology to formulate a set of preliminary recommendations on long-term SSRI use. A review of data in these areas supports three conclusions. First, for children who achieve marked reduction in anxiety or depressive symptoms on an SSRI, clinicians should consider recommending a medication-free trial. Second, when indicated, this medication-free trial should coincide with the first low-stress period occurring after 1 year of continual SSRI treatment. Third, SSRI treatment should be reinitiated in children who exhibit signs of relapse during this medication-free trial.
本文探讨了儿童和青少年使用选择性5-羟色胺再摄取抑制剂（SSRI）的一个关键问题。简要回顾一下，近期的随机对照试验已证实SSRI在儿童和青少年重度抑郁及焦虑症急性治疗中的安全性和有效性。鉴于这些数据，对于那些从SSRI治疗中获得显著短期益处的儿童和青少年，长期使用SSRI的潜在风险和益处引发了一些主要问题。当前综述总结了关于纵向结果、神经科学和精神药理学的研究，以制定一套关于长期使用SSRI的初步建议。对这些领域数据的综述支持三个结论。第一，对于使用SSRI后焦虑或抑郁症状显著减轻的儿童，临床医生应考虑建议进行停药试验。第二，如有必要，此停药试验应与持续使用SSRI一年后出现的首个低压力期同时进行。第三，在停药试验期间出现复发迹象的儿童应重新开始使用SSRI治疗。
