Melvin Glenn A, Finnin Linda, Taffe John, Dudley Amanda L, Klimkeit Ester I, Gordon Michael S, Tonge Bruce
Centre for Developmental Psychiatry and Psychology, School of Clinical Sciences, Monash University, Australia.
Centre for Educational Development, Appraisal and Research, University of Warwick, UK.
Clin Child Psychol Psychiatry. 2019 Oct;24(4):892-905. doi: 10.1177/1359104518822681. Epub 2019 Jan 12.
Investigating adverse events associated with antidepressant treatments in adolescents is important given the concerns about increased risk of suicidal ideation and behavior in this age group. The aim of this study is to investigate adverse and serious adverse events associated with the treatment of anxiety (cognitive behavioral therapy (CBT)-only, CBT-plus-placebo, and CBT-plus-fluoxetine) in anxious school-refusing adolescents.
A side-effect symptom checklist was completed by participants prior to commencing treatment and during treatment (weekly/fortnightly).
CBT-plus-fluoxetine was well tolerated and not associated with higher levels of adverse events than the other treatments. Adverse events in all groups decreased over time, and the only adverse event distinct to fluoxetine was nausea. Baseline anxiety predicted higher levels of adverse events. There was one suicide attempt in the CBT-plus-placebo group but no statistically significant difference in suicide attempts between groups. Participants with a comorbid depressive disorder were more likely to report self-injury ideation but not suicidal ideation compared with those who did not have comorbid depressive disorder. Frequency of suicidal ideation and non-suicidal self-injury was significantly lower in the CBT-plus-fluoxetine group compared with the CBT-only group. Frequency of self-injury ideation was significantly lower in the CBT-plus-fluoxetine group compared with both other groups.
Overall, the treatments were well tolerated and fluoxetine plus CBT appeared to be protective against suicidal ideation, non-suicidal self-injury, and self-injury ideation in this sample.
鉴于对青少年自杀意念和行为风险增加的担忧，调查与青少年抗抑郁治疗相关的不良事件非常重要。本研究的目的是调查在拒绝上学的焦虑青少年中，与焦虑治疗（仅认知行为疗法（CBT）、CBT加安慰剂、CBT加氟西汀）相关的不良和严重不良事件。
参与者在开始治疗前和治疗期间（每周/每两周）完成一份副作用症状清单。
CBT加氟西汀耐受性良好，与其他治疗相比，不良事件水平并不更高。所有组的不良事件随时间减少，氟西汀特有的唯一不良事件是恶心。基线焦虑预示着更高水平的不良事件。CBT加安慰剂组有1例自杀未遂，但各组间自杀未遂情况无统计学显著差异。与无共病抑郁症的参与者相比，患有共病抑郁症的参与者更有可能报告自伤意念而非自杀意念。与仅CBT组相比，CBT加氟西汀组的自杀意念和非自杀性自伤频率显著更低。与其他两组相比，CBT加氟西汀组的自伤意念频率显著更低。
总体而言，这些治疗耐受性良好，在本样本中，氟西汀加CBT似乎对自杀意念、非自杀性自伤和自伤意念具有保护作用。
