黑箱之外：重新评估儿科抗抑郁药处方
Outside the Black Box: Re-assessing Pediatric Antidepressant Prescription.
作者信息
Sparks Jacqueline A, Duncan Barry L
机构信息
University of Rhode Island, Kingston, Rhode Island, USA.
出版信息
J Can Acad Child Adolesc Psychiatry. 2013 Aug;22(3):240-6.
OBJECTIVE
The purpose of this review is to assess whether evidence supports a favorable risk/benefit profile for pediatric antidepressant use and reconsideration of the black box.
METHOD
The review examines studies post-black box purporting to show declines in pediatric antidepressant use and rising youth suicide, summarizes evidence for efficacy and safety of pediatric antidepressants, and discusses irregularities in recent meta-analyses of fluoxetine for youth.
RESULTS
Pediatric antidepressant prescription did not significantly decline post-black box and youth suicide has risen only in recent years. Recent meta-analyses fail to undermine evidence that antidepressants are associated with increased risk of suicidality in youth.
CONCLUSIONS
First line prescription of antidepressants for youth is not advisable. The black box and international warnings on pediatric use of antidepressants are warranted. Wider availability of psychosocial options for depressed youth is recommended.
目的
本综述的目的是评估是否有证据支持儿科使用抗抑郁药具有良好的风险/效益比，以及是否应重新考虑加黑框警告。
方法
本综述考察了加黑框警告后声称儿科抗抑郁药使用量下降以及青少年自杀率上升的研究，总结了儿科抗抑郁药疗效和安全性的证据，并讨论了近期关于氟西汀治疗青少年的荟萃分析中的异常情况。
结果
加黑框警告后儿科抗抑郁药处方量并未显著下降，且青少年自杀率仅在近年来有所上升。近期的荟萃分析未能削弱抗抑郁药与青少年自杀风险增加相关的证据。
结论
不建议将抗抑郁药作为青少年的一线处方用药。对儿科使用抗抑郁药的黑框警告及国际警示是有必要的。建议为抑郁青少年提供更多社会心理治疗选择。
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