Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy.
Psychother Psychosom. 2013;82(3):132-41. doi: 10.1159/000345316. Epub 2013 Mar 21.
The prevalence, characteristics and implications of excessive arousal-activation in children and adolescents treated with antidepressants for specific illnesses have not been systematically examined.
We compared reports of antidepressant trials (n = 6,767 subjects) in juvenile depressive (n = 17) and anxiety disorders (n = 25) for consensus-based indications of psychopathological mood elevation or behavioral activation.
Rates of excessive arousal-activation during treatment with antidepressants were at least as high in juvenile anxiety (13.8%) as depressive (9.79%) disorders, and much lower with placebos (5.22 vs. 1.10%, respectively; both p < 0.0001). The antidepressant/placebo risk ratio for such reactions in paired comparisons was 3.50 (12.9/3.69%), and the meta-analytically pooled rate ratio was 1.7 (95% confidence interval: 1.2-2.2; both p ≤ 0.001). Overall rates for 'mania or hypomania', specifically, were 8.19% with and 0.17% without antidepressant treatment, with large drug/placebo risk ratios among depressive (10.4/0.45%) and anxiety (1.98/0.00%) disorder patients.
Risks of excessive mood elevation during antidepressant treatment, including mania-hypomania, were much greater than with placebo, and similar in juvenile anxiety and depressive disorders. Excessive arousal-activation in children or adolescents treated with antidepressants for anxiety as well as depressive disorders calls for particular caution and monitoring for potential risk of future bipolar disorder.
在针对特定疾病接受抗抑郁治疗的儿童和青少年中，过度觉醒-激活的流行率、特征和影响尚未得到系统研究。
我们比较了青少年抑郁（n = 17）和焦虑障碍（n = 25）抗抑郁药物试验（n = 6767 例）的报告，以寻找基于共识的精神病理学情绪升高或行为激活的指征。
在接受抗抑郁药物治疗期间，过度觉醒-激活的发生率在青少年焦虑症（13.8%）中至少与抑郁症（9.79%）一样高，而安慰剂组则要低得多（分别为 5.22%和 1.10%；均 p < 0.0001）。在配对比较中，此类反应的抗抑郁药/安慰剂风险比为 3.50（12.9/3.69%），荟萃分析的汇总率比为 1.7（95%置信区间：1.2-2.2；均 p ≤ 0.001）。总体而言，“躁狂或轻躁狂”的发生率为抗抑郁治疗组 8.19%，无抗抑郁治疗组为 0.17%，其中抑郁症（10.4/0.45%）和焦虑症（1.98/0.00%）患者的药物/安慰剂风险比均较大。
抗抑郁治疗期间过度情绪升高（包括躁狂-轻躁狂）的风险明显大于安慰剂，且在青少年焦虑症和抑郁症中相似。在接受抗抑郁药物治疗的儿童或青少年中，焦虑症和抑郁症都可能出现过度觉醒-激活，需要特别谨慎和监测潜在的双相情感障碍风险。
