Adverse events reported by anxious school refusing adolescents receiving cognitive behavioral therapy with and without fluoxetine

Abstract

Background: 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. Methods: A side-effect symptom checklist was completed by participants prior to commencing treatment and during treatment (weekly/fortnightly). Results: 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. Conclusions: 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.

Psychotropic drugs for the treatment of non-suicidal self-injury in children and adolescents: a systematic review and meta-analysis

“…In total, seven studies were included in our qualitative synthesis (see Table 1; data extraction performed independently by two authors, VE and EW) [29][30][31][32][33][34][35]. From these seven studies, four RCTs [29,[31][32][33] serotonin reuptake inhibitors (SSRIs) as a class of antidepressants and were included in quantitative analyses with a total N = 1193.…”

Prefrontal cortex neural activity predicts reduction of non-suicidal self-injury in adolescents with major depressive disorder: An event related potential study

“…The results of a study in the group of adolescent refractory depression show that the subjects who choose SSRI for intervention have the lowest incidence of self-injury behavior ( Brent et al, 2009 ). Glenn found that among adolescents with anxiety disorder, the frequency of self-injury in the intervention group combined with fluoxetine decreased significantly compared with adolescents who only used cognitive behavioral therapy ( Melvin et al, 2019 ). However, a recent meta-analysis of psychotropic drugs for the treatment of NSSI in children and adolescents showed that there was no statistically significant difference in the occurrence of NSSI in adolescents between SSRI and the control group (drug or placebo) ( Eggart et al, 2022 ).…”

Adverse Events in Cognitive Behavioral Therapy and Relaxation Training for Children and Adolescents with Obsessive-Compulsive Disorder: A Mixed Methods Study and Analysis Plan for the TECTO Trial

“…In ERP, the therapist introduces test exposures to determine the individual's anxiety tolerance level to secure optimal learning and minimize unnecessary distress [12]. Even when gradual exposures are implemented properly, some youths may be at risk of experiencing adverse events due to comorbid psychiatric disorders, impaired intelligence, strains in family relations, poor therapeutic alliance, or high baseline anxiety levels [14,15,22,23]. One alternative treatment option is psychoeducation and relaxation training (PRT), which comprises breathing practices and muscle relaxation exercises without ERP [24].…”