Sudden Death Related to Selected Tricyclic Antidepressants in Children

Varley, Christopher K.

doi:10.2165/00128072-200103080-00006

“…124 As with the other tricyclics, clomipramine can cause a prolongation of the QT interval. 131 Clomipramine is also associated with a range of other side effects, such as tachycardia, fatigue, dizziness, dry mouth, sweating, tremor, constipation, urinary retention, and weight gain. Thus, clomipramine is generally not the drug of first choice for OCD.…”

Section: Pharmacotherapy For Ocd: Conclusionmentioning

confidence: 99%

Contemporary assessment and pharmacotherapy of Tourette syndrome

Scahill

¹

,

Erenberg

²

,

Berlin

³

et al. 2006

NeuroRX

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Summary:To develop a guide to clinical assessment and pharmacotherapy for children and adults with Tourette syndrome (TS), we reviewed published literature over the past 25 years to identify original articles and reviews on the assessment and pharmacological treatment of Tourette syndrome, attention-deficit/hyperactivity disorder (ADHD) and obsessivecompulsive disorder (OCD). The literature search also included a survey of reviews published in book chapters. The assessment section was compiled from several reviews. Pharmacological treatments were classified into those with strong empirical support (as evidenced by two positive placebo-controlled studies for tics, OCD, or ADHD in TS samples); modest empirical support (one positive placebo-controlled study), or minimal support (open-label data only). We conclude that accurate diagnosis, including identification of comorbid conditions, is an essential step toward appropriate treatment for patients with TS. In many patients with TS, symptom management requires pharmacotherapy for tics or coexisting conditions. The evidence supporting efficacy and safety for medications used in patients with TS varies. But this evidence offers the best guide to clinical practice.

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“…131,154 Nortriptyline, also a tricyclic, has been less well studied in ADHD. In doses ranging from 50 to 200 mg/day given in divided doses, bupropion was generally well tolerated and equal to methylphenidate in one study 155 and superior to placebo.…”

Section: Treatment Of Adhdmentioning

confidence: 99%

Contemporary assessment and pharmacotherapy of Tourette syndrome

Scahill

¹

,

Erenberg

²

,

Berlin

³

et al. 2006

View full text Add to dashboard Cite

Summary:To develop a guide to clinical assessment and pharmacotherapy for children and adults with Tourette syndrome (TS), we reviewed published literature over the past 25 years to identify original articles and reviews on the assessment and pharmacological treatment of Tourette syndrome, attention-deficit/hyperactivity disorder (ADHD) and obsessivecompulsive disorder (OCD). The literature search also included a survey of reviews published in book chapters. The assessment section was compiled from several reviews. Pharmacological treatments were classified into those with strong empirical support (as evidenced by two positive placebo-controlled studies for tics, OCD, or ADHD in TS samples); modest empirical support (one positive placebo-controlled study), or minimal support (open-label data only). We conclude that accurate diagnosis, including identification of comorbid conditions, is an essential step toward appropriate treatment for patients with TS. In many patients with TS, symptom management requires pharmacotherapy for tics or coexisting conditions. The evidence supporting efficacy and safety for medications used in patients with TS varies. But this evidence offers the best guide to clinical practice.

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“…CMI should not, however, be a first-line treatment in children and youth with OCD because of its pharmacokinetic properties and side effect profile. Risks of toxicity include seizures and ECG changes (therefore, ECG monitoring is recommended); rare cases of sudden death have been reported in children taking tricyclic antidepressants (72).…”

Section: Pharmacotherapy Of Ocd In Children and Adolescentsmentioning

confidence: 99%

Pharmacotherapies in the Management of Obsessive—Compulsive Disorder

Blier

¹

,

Habib

²

,

Flament

³

2006

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T he first reports of the potential for medications to exert an antiobsessional effect in patients without major depression were published about 35 years ago (1-4). The tricyclic antidepressant G-34586, or CMI, was used successfully in these first attempts. The serendipitous finding of its beneficial effect on obsessions in depression patients motivated its use in that disorder. Several case series in the following decade seemed to confirm the usefulness of this medication in treating OCD, then denoted obsessive-compulsive neurosis. The first controlled trials demonstrating a therapeutic action of CMI in OCD were published in 1980 (5,6). These were followed by many positive studies (see 7 for a review). Clinical Implications· OCD is a chronic disorder amenable to pharmacotherapy using a single class of medications: the potent SRIs. · With a good knowledge of the properties of these drugs, optimal response and patient safety and comfort can be achieved. · It is possible to augment the anti-OCD response with various augmentation strategies. · The response to various pharmacotherapies is generally partial, and their administration must be prolonged to avoid the resurgence of symptoms. Limitations· SRIs exert class side effects that are sometimes difficult to minimize. · Few augmentation strategies are supported by double-blind studies.Few medications are effective in treating obsessive-compulsive disorder (OCD). As monotherapy, only potent serotonin (5-HT) reuptake inhibitors (SRIs) consistently exert an intrinsic therapeutic action in OCD. Their use in OCD, however, differs from their use in depression. This paper first reviews the evidence supporting the key role of 5-HT as a pivotal neurotransmitter in the anti-OCD response. Then, we describe the practicalities of SRI use, followed by the steps that can be taken when these medications do not produce an adequate clinical response. We provide specifics for the treatment of children and adolescents with OCD. We include a brief description of the brain circuitry involved in OCD and the mechanisms of action of the pharmacologic agents reported to be effective in this disorder, as well as those that are useful in depression but not in OCD. We present this information to promote better understanding of the research endeavours needed to develop new pharmacotherapeutic approaches. Information on funding and support and author affiliations appears at the end of the article.

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Sudden Death Related to Selected Tricyclic Antidepressants in Children

Cited by 45 publications

References 68 publications

Contemporary assessment and pharmacotherapy of Tourette syndrome

Contemporary assessment and pharmacotherapy of Tourette syndrome

Contemporary assessment and pharmacotherapy of Tourette syndrome

Pharmacotherapies in the Management of Obsessive—Compulsive Disorder

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