Extended Open-Label Fluoxetine Treatment of Adolescents with Major Depression

Abstract

Fluoxetine was used to treat nine adolescents (ages 15 to 18) with a DSM-III-R diagnosis of major depression who had failed to respond to milieu or intensive individual psychotherapy. One patient developed a hypomanic episode after 8 weeks, and fluoxetine was discontinued. Seven of the eight patients who continued open-label treatment showed "very much" or "much" clinical improvement, as measured by the Clinical Global Impression Scale, by 24 weeks of treatment. A greater than 50% reduction in symptoms on the Beck Depression Inventory was reported by most patients following 4 to 12 weeks of treatment. Similar reductions were clinically observed (over 50% reduction on the Hamilton Depression Rating Scale) after 4 to 12 weeks. Self-reported depression ratings at weeks 12,16, and 24 were significantly lower than those at weeks 2 and 4. Patients whose depressive episode had lasted less than 6 months reported significantly fewer symptoms by week 8 of treatment than patients with a longer duration of illness, but extending the duration of treatment increased apparent treatment response in those patients with long illness duration. Self-report ratings of suicidal ideation decreased by more than 50% for most patients between weeks" 6 and 16 of treatment. No patient reported an increase in suicidal ideation during fluoxetine treatment. The most common side effects, behavioral activation (increased activity, silliness, disruptive behavior) and gastrointestinal complaints, were transient and well tolerated. These uncontrolled clinical data suggest that fluoxetine might have some value in treating adolescents with major depression, but controlled studies with larger samples are needed before claims about efficacy can be ventured or the use of fluoxetine can be recommended for treating adolescent depression. These preliminary data also suggest that extending a fluoxetine trial beyond 8 weeks might enhance clinical response, especially in adolescents whose major depressive episode has lasted more than 6 months. ¥

Mirtazapine in the Treatment of Adolescents with Major Depression: An Open-Label, Multicenter Pilot Study

“…On the CGI-I scale, mirtazapine treatment resulted in some improvement in 87% of subjects. Response according to the CGI-I (74%) was comparable to that found in other open-label studies with the antidepressants sertraline, fluoxetine, and nefazodone (Ambrosini et al 1999;Colle et al 1994;Nixon et al 2001;Goodnick et al 2000). In recent placebo-controlled studies, the respective percentages of responders according to the CGI-I in placebo-controlled studies have been 52%-56% of those receiving fluoxetine versus 33%-37% receiving a placebo (Emslie et al 1997;, and 66% of paroxetine subjects versus 48% of placebo subjects (Keller 2001).…”

Mirtazapine in the Treatment of Adolescents with Major Depression: An Open-Label, Multicenter Pilot Study

“…On the CGI-I scale, mirtazapine treatment resulted in some improvement in 87% of subjects. Response according to the CGI-I (74%) was comparable to that found in other open-label studies with the antidepressants sertraline, fluoxetine, and nefazodone (Ambrosini et al 1999;Colle et al 1994;Nixon et al 2001;Goodnick et al 2000). In recent placebo-controlled studies, the respective percentages of responders according to the CGI-I in placebo-controlled studies have been 52%-56% of those receiving fluoxetine versus 33%-37% receiving a placebo (Emslie et al 1997;, and 66% of paroxetine subjects versus 48% of placebo subjects (Keller 2001).…”

A Retrospective Study of Citalopram in Adolescents with Depression

“…Response to citalopram in this current series (76%) is higher than that described in controlled pediatric trials of SSRIs for depression (Emslie et al 1997;Keller et al 1998) but similar to open trials of fluoxetine (Colle et al 1994), sertraline (Ambrosini et al 1999;McConville et al 1996), and paroxetine (Rey-Sanchez and Gutierrez-Casares 1997). In five published retrospective chart reviews, approximately 68% of juveniles with depressive disorders improved on SSRIs, including fluoxetine (Jain et al 1992), sertraline (Tierney et al 1995), and paroxetine (Cosgrove 1994;Masi et al 1997).…”

Pharmacological Treatment of Adolescent Major Depression

“…Besides three studies with fluoxetine (Boulos et al 1992;Colle et al 1994;Ghazziuddin et al 1995), one with paroxetine (Rey-Sanchez and Gutierrez-Casares 1997), and three with sertraline (Alderman et al 1998;Ambrosini et al 1999;McConville et al 1996), we found one open trial conducted with fluvoxamine at a daily dose of 100 to 300 mg for 8 weeks, with six adolescents ages 13-18 years; all showed improvement on the Beck Depression Inventory (Apter et al 1994).…”

Mirtazapine in the Treatment of Adolescents with Major Depression: An Open-Label, Multicenter Pilot Study

“…On the CGI-I scale, mirtazapine treatment resulted in some improvement in 87% of subjects. Response according to the CGI-I (74%) was comparable to that found in other open-label studies with the antidepressants sertraline, fluoxetine, and nefazodone (Ambrosini et al 1999;Colle et al 1994;Nixon et al 2001;Goodnick et al 2000). In recent placebo-controlled studies, the respective percentages of responders according to the CGI-I in placebo-controlled studies have been 52%-56% of those receiving fluoxetine versus 33%-37% receiving a placebo (Emslie et al 1997;, and 66% of paroxetine subjects versus 48% of placebo subjects (Keller 2001).…”

A Retrospective Study of Citalopram in Adolescents with Depression

“…Response to citalopram in this current series (76%) is higher than that described in controlled pediatric trials of SSRIs for depression (Emslie et al 1997;Keller et al 1998) but similar to open trials of fluoxetine (Colle et al 1994), sertraline (Ambrosini et al 1999;McConville et al 1996), and paroxetine (Rey-Sanchez and Gutierrez-Casares 1997). In five published retrospective chart reviews, approximately 68% of juveniles with depressive disorders improved on SSRIs, including fluoxetine (Jain et al 1992), sertraline (Tierney et al 1995), and paroxetine (Cosgrove 1994;Masi et al 1997).…”

Pharmacological Treatment of Adolescent Major Depression

“…Besides three studies with fluoxetine (Boulos et al 1992;Colle et al 1994;Ghazziuddin et al 1995), one with paroxetine (Rey-Sanchez and Gutierrez-Casares 1997), and three with sertraline (Alderman et al 1998;Ambrosini et al 1999;McConville et al 1996), we found one open trial conducted with fluvoxamine at a daily dose of 100 to 300 mg for 8 weeks, with six adolescents ages 13-18 years; all showed improvement on the Beck Depression Inventory (Apter et al 1994).…”

Mirtazapine in the Treatment of Adolescents with Major Depression: An Open-Label, Multicenter Pilot Study

“…On the CGI-I scale, mirtazapine treatment resulted in some improvement in 87% of subjects. Response according to the CGI-I (74%) was comparable to that found in other open-label studies with the antidepressants sertraline, fluoxetine, and nefazodone (Ambrosini et al 1999;Colle et al 1994;Nixon et al 2001;Goodnick et al 2000). In recent placebo-controlled studies, the respective percentages of responders according to the CGI-I in placebo-controlled studies have been 52%-56% of those receiving fluoxetine versus 33%-37% receiving a placebo (Emslie et al 1997;, and 66% of paroxetine subjects versus 48% of placebo subjects (Keller 2001).…”

A Retrospective Study of Citalopram in Adolescents with Depression

“…Response to citalopram in this current series (76%) is higher than that described in controlled pediatric trials of SSRIs for depression (Emslie et al 1997;Keller et al 1998) but similar to open trials of fluoxetine (Colle et al 1994), sertraline (Ambrosini et al 1999;McConville et al 1996), and paroxetine (Rey-Sanchez and Gutierrez-Casares 1997). In five published retrospective chart reviews, approximately 68% of juveniles with depressive disorders improved on SSRIs, including fluoxetine (Jain et al 1992), sertraline (Tierney et al 1995), and paroxetine (Cosgrove 1994;Masi et al 1997).…”

Pharmacological Treatment of Adolescent Major Depression

“…Besides three studies with fluoxetine (Boulos et al 1992;Colle et al 1994;Ghazziuddin et al 1995), one with paroxetine (Rey-Sanchez and Gutierrez-Casares 1997), and three with sertraline (Alderman et al 1998;Ambrosini et al 1999;McConville et al 1996), we found one open trial conducted with fluvoxamine at a daily dose of 100 to 300 mg for 8 weeks, with six adolescents ages 13-18 years; all showed improvement on the Beck Depression Inventory (Apter et al 1994).…”