University Hospitals Case Medical Center, Division of Child and Adolescent Psychiatry, Cleveland, OH 44106, USA.
Expert Opin Pharmacother. 2012 Oct;13(15):2119-30. doi: 10.1517/14656566.2012.726613.
In 2003, public health advisories in North America and Europe regarding suicidality associated with selective serotonin reuptake inhibitors (SSRIs) led to the addition of black box warnings to antidepressant package inserts in 2004. Subsequently, a series of events appeared to result from these regulatory actions.
This review provides an overview of the temporal associations of regulatory agencies' actions in North America and Europe with rates of depression diagnoses, pediatric antidepressant prescription rates, follow-up visits to physicians prescribing antidepressants, and rates of completed suicide and suicidal ideation in children and adolescents. In addition, evidence-based predictors of suicidal behavior and suicide risk, as provided by large, multisite studies of depressed children and adolescents, are outlined. Finally, this review considers key advancements in the study of young patients at risk for suicide and describes innovations in current research methodology, to more accurately identify suicidality and the relationship to antidepressant use within this vulnerable patient population.
Evaluating the role of antidepressants in those youths who do not respond to evidence-based psychotherapeutic interventions may be a useful future research direction. Until more data are available, however, closely monitored antidepressant treatment in combination with CBT may provide the most benefit.
2003 年，针对与选择性 5-羟色胺再摄取抑制剂（SSRIs）相关的自杀倾向，北美和欧洲发布了公共卫生建议，这导致 2004 年在抗抑郁药包装说明书中添加了黑框警告。此后，一系列事件似乎是这些监管行动的结果。
本综述概述了北美的监管机构行动与抑郁症诊断率、儿科抗抑郁药处方率、开抗抑郁药的医生随访次数以及儿童和青少年的自杀率和自杀意念率之间的时间关联。此外，还概述了大型多地点研究为抑郁儿童和青少年提供的基于证据的自杀行为和自杀风险预测因素。最后，本综述考虑了处于自杀风险中的年轻患者研究的关键进展，并描述了当前研究方法的创新，以更准确地识别易患自杀的人群，并确定与该脆弱患者群体使用抗抑郁药的关系。
评估抗抑郁药在那些对抗抑郁药治疗和认知行为疗法等循证心理治疗干预无反应的青少年中的作用，可能是未来有用的研究方向。然而，在更多数据可用之前，密切监测抗抑郁药治疗与认知行为疗法相结合可能会带来最大的益处。
