Bailly Daniel
Service hospitalo-universitaire de psychiatrie, Hôpital Sainte-Marguerite, Marseille (13).
Presse Med. 2006 Oct;35(10 Pt 2):1507-15. doi: 10.1016/s0755-4982(06)74843-6.
Some behavioral side effects of selective serotonin reuptake inhibitor (SSRI) antidepressants have been known for a long time. Since the introduction of these drugs in the 1990s, publications have regularly reported behavioral side effects in children and adolescents, including excitation, motor restlessness, social disinhibition, and above all self-injurious ideation and behavior. Clinical trials provide only limited data. Although these data suggest that some self-injurious and suicidal behavior may indeed occur in children and adolescents receiving SSRIs, they are too disparate to specify the frequency of these acts. Clinical trials provide useful data about drug efficacy, but their methodology is inappropriate for determining the frequency of such side effects. SSRI and suicidality: the data are difficult to read. Although some epidemiologic data suggest that SSRIs may increase the risk of occurrence of self-injurious and suicidal behavior in children and adolescents, other epidemiologic data show that the rate of suicide mortality in children and adolescents has decreased since the introduction of SSRIs. No known mechanism explains how SSRIs might increase the risk of these behavioral side effects. It is clear, however, that these effects are not particular to children and adolescents but may also be observed among adults. SSRIs must be used rationally and carefully in children and adolescents. They should not be administered routinely in youth with obsessive-compulsive or depressive disorders. Their use should be reserved for severe disorders or when psychotherapy alone has been shown to be inadequate, and when they are used, efficacy and side effects must be monitored carefully and frequently.
选择性5-羟色胺再摄取抑制剂（SSRI）类抗抑郁药的一些行为副作用早已为人所知。自20世纪90年代这类药物问世以来，出版物经常报道儿童和青少年中的行为副作用，包括兴奋、运动不安、社交抑制，尤其是自伤意念和行为。临床试验提供的数据有限。尽管这些数据表明，接受SSRI治疗的儿童和青少年中可能确实会出现一些自伤和自杀行为，但这些数据差异太大，无法明确这些行为的发生频率。临床试验提供了关于药物疗效的有用数据，但其方法不适用于确定此类副作用的发生频率。SSRI与自杀倾向：数据难以解读。尽管一些流行病学数据表明，SSRI可能会增加儿童和青少年自伤和自杀行为的发生风险，但其他流行病学数据显示，自SSRI问世以来，儿童和青少年的自杀死亡率有所下降。目前尚无已知机制解释SSRI如何可能增加这些行为副作用的风险。然而，很明显，这些影响并非儿童和青少年所特有，在成年人中也可能观察到。在儿童和青少年中必须合理、谨慎地使用SSRI。不应在患有强迫症或抑郁症的青少年中常规使用。其使用应仅限于严重疾病，或在单独的心理治疗已被证明不足时，并且在使用时，必须仔细且频繁地监测疗效和副作用。
