Cheung Amy H, Dewa Carolyn S, Levitt Anthony J
Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto.
Paediatr Child Health. 2005 Oct;10(8):457-63.
Recent controversy surrounding the use of non-tricyclic antidepressants and the emergence of suicide-related events, hostility/behavioural activation and mania in youth with depression warrants an exploration of the results from randomized controlled trials (RCTs) and published case reports for the emergence of these adverse events.
To provide a clinical review of the available evidence from RCTs and case reports regarding the safety of nontricyclic anti-depressants in youth with depression.
Seven RCTs of antidepressant use in youth with depression, four case reports of suicide-related adverse events, three case reports of hostility/behavioural activation, and 12 case reports of precipitation of mania were reviewed.
The majority of patients with suicide-related adverse events from both RCTs and published case reports were suicidal before the start of antidepressant treatment. Hostility/behavioural activation generally developed within days to weeks after the start of antidepressant treatment; in the majority of cases, symptoms resolved within four weeks of dosage lowering or discontinuation of the medication alone. Rates for precipitation of mania from RCTs ranged from 0% to 6%. In approximately 60% of published case reports, manic symptoms resolved with the discontinuation or lowering of the dosage of medication alone.
Several trends were observed in the association between adverse events and the use of nontricyclic antidepressants in youth. When prescribing antidepressants to youth, clinicians should closely monitor patients and fully inform them and their families of the risks and benefits of treatment with antidepressants.
近期围绕非三环类抗抑郁药的使用存在争议，且抑郁症青少年中出现了与自杀相关的事件、敌意/行为激活及躁狂症状，因此有必要探讨随机对照试验（RCT）的结果以及已发表的病例报告中这些不良事件的出现情况。
对RCT和病例报告中有关非三环类抗抑郁药在抑郁症青少年中安全性的现有证据进行临床综述。
对七项关于抑郁症青少年使用抗抑郁药的RCT、四项与自杀相关不良事件的病例报告、三项敌意/行为激活的病例报告以及十二项躁狂发作的病例报告进行了综述。
RCT和已发表病例报告中，大多数与自杀相关不良事件的患者在开始抗抑郁治疗前就有自杀倾向。敌意/行为激活通常在开始抗抑郁治疗后的数天至数周内出现；在大多数情况下，症状在降低剂量或仅停用药物后的四周内缓解。RCT中躁狂发作的发生率为0%至6%。在大约60%已发表的病例报告中，仅通过停用或降低药物剂量，躁狂症状就得到缓解。
在青少年不良事件与使用非三环类抗抑郁药之间的关联中观察到了几种趋势。在给青少年开抗抑郁药时，临床医生应密切监测患者，并充分告知他们及其家人抗抑郁治疗的风险和益处。
