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KMID : 0367320030140010012
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Journal of the Korean Academy of Child and Adolescent Psychiatry
2003 Volume.14 No. 1 p.12 ~ p.25
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NEW DRUG THERAPY IN CHILD AND ADOLESCENT PSYCHIATRY
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Lee Soo-Jung
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Abstract
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Objectives : As increasing number of new antidepressants have been being introduced in clinical practice, pharmacological understanding has been broadened. These changes mandate new information and theories to be incorporated into the treatment process of children with depressive disorders. In light of newly coming knowledge, this review intended to recapitulate the characteristics of new antidepressants and to consider the pivotal issues to develope guidelines for the treatment of depression in childhood and adolescence.
Methods : Searching the Pub-Med online database for the articles with the key words of "new", "anti-depressants", and "children", ninety-seven headings of review articles were obtained. The author selected the articles of pertinent subjects in terms of either treatment guideline or psychopharmacology of new antidepressants. When required, articles about the clinical effectiveness of individual antidepressants were separatedly searched. In addition, the safety infornation of new antidepressants was acquired by browsing the official sites of the United States Food and Drugs Administration and Department of Health and Human Services.
Results : 1) For the clinical course, treatment phase, and treatment outcome, the reviews or treatment guidelines adopted the information from adult treatment guidelines. 2) Systematic and critical reviews unambiguously concluded that selective serotonin reuptake inhibitors (SSRIs) excelled tricyclic antidepressants (TCAs) for both efficacy and side effect profiles, and were recommend for the first-line choice for the treatment of children with depressive disorders. 3) New antidepressants generally lacked treatment experiences and randomized controlled clinical trials. 4) SSRIs and other new antidepressants, when used together, might result in pharmacokinetic and/or pharmacodynamic drug-to-drug interaction. 5) The difference of the clinical effectiveness of antidepressants between children and adults should be addressed from developmental aspects, which required further evidence.
Conclusion : Treatment guidelines for the pharmacological treatment of childhood and adolescence depression could be constructed on the basis of clinical trial findings and practical experiences. Treatment guidelines are to best serve as the frame of reference for a clinician to make reasonable decisions for a particular therapeutic situation. In order to fulfill this role, guidelines should be updated as soon as new research data become available.
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KEYWORD
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Child, Adolescent, Antidepressane
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