Comprehensive management of antidepressant therapy in pediatric psychiatry

Resumo

The management of antidepressant medications in children and adolescents involves careful consideration due to their unique pharmacokinetic and pharmacodynamic profiles. Pharmacists are integral to this process, ensuring medications are used correctly and monitoring for efficacy and adverse effects. Antidepressants are prescribed for various conditions including major depression, obsessive-compulsive disorder, and anxiety disorders. Given the age-specific metabolic differences, treatment must be tailored and closely monitored for side effects such as weight gain, sleep disturbances, and impacts on neuromotor development. The review by Cardy, Dhaliwal, and Reddy (2017) highlights the increased use of antidepressants in pediatric patients since the late 1990s, with a resurgence after a brief decline due to regulatory concerns. The prevalence of off-label prescribing, despite limited FDA approval for many antidepressants in this age group, raises important questions about their efficacy and safety. Walkup (2017) emphasizes the pharmacist’s role in managing these treatments, stressing the need for careful monitoring and individualized treatment plans. Taurines et al. (2011) outline the importance of combining antidepressant therapy with non-pharmacological interventions such as psychotherapy for managing severe depressive symptoms. Hetrick et al. (2012) review the effectiveness of newer antidepressants, particularly SSRIs, noting modest benefits but also an increased risk of suicide-related outcomes, recommending fluoxetine as a first-choice option. Díaz-Caneja et al. (2014) investigate the rise of polypharmacy involving antidepressants and other psychotropic drugs, highlighting the need for more research to understand its efficacy and safety. Lastly, Luft et al. (2018) address the issue of activation symptoms associated with antidepressants, underscoring the need for better understanding and management. Overall, a collaborative approach involving pharmacists, clinicians, and researchers is essential to ensure safe and effective antidepressant therapy for pediatric patients, emphasizing the need for continued research and evidence-based practices.