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来自皮耶及玛丽居礼大学（巴黎第六大学）的David Cohen在日前出版的《精神疗法与身心医学》上探讨了在实际临床中一个热门的话题：如何在儿童和亲少年中使用抗抑郁药。

美国和欧洲的药监部门警告称治疗儿童和青少年抑郁症应避免使用SSRIs（选择性5羟色胺再吸收抑制剂）。这使得很多医生都感到惊讶，他们在做出治疗决定的时候都是基于药监部门通过成人临床试验后得来的数据。在这篇文章中提到了SSRIs的作用机理以及使用特点。包括十篇报道，总共2046名受试患者，评估了四种SSRIs（氟西汀、帕罗西丁、舍曲林、西他罗仑）在治疗青少年儿童抑郁症中的功效作用。文章称，有附加的6次试验（总共1，234名患者）数据并没有报道出来，它们或者由于没有功效或者存在可疑的副作用，其中包括自杀行为等。

Meta分析显示四种药物中除了氟西汀以外，试验数据并不支持SSRIs的使用。为便于给实际临床使用提供明确的参考，有必要解释一些特殊的疑点，如（1）SSRIs与抑郁症、自杀倾向之间的联系；（2）SSRIs与年龄相关的特殊功效；（3）在青年儿童抑郁症中安慰剂有着很高的功效作用。在严重且有耐药性的青年儿童抑郁症患者中SSRIs仍然可以作为二线药物的选择。然而，只有有经验的主任医师才能对青年儿童患者使用SSRIs。

Should Antidepressant Drugs Be Banned In Children?

Main Category: Pediatrics News
Article Date: 01 Jan 2007 - 0:00 PST
A review by David Cohen (Universite Pierre et Marie Curie) addresses a hot topic in clinical proctice: the prescription of antidepressant drugs in children and adolescents in the current issue of Psychotherapy and Psychosomatics.

European and US pharmaceutical agencies have recently warned against the use of selective serotonin reuptake inhibitors (SSRIs) in child and adolescent depression. This came as a surprise to many practitioners, who had made treatment decisions based on data from pharmaceutical trials using adult samples.

The author reviews the recent literature relevant to the use of SSRIs in youth depression, including psychiatric clinical trials, pharmacology and drug safety data.

Recommendations and rationales for the use of SSRIs in this context are offered. Ten publications, comprising a total of 2,046 patients, evaluated the efficacy of four SSRIs (fluoxetine, paroxetine, sertraline and citalopram) in child and adolescent depression. It is noted that an additional 6 trials (with a total of 1,234 patients) were not reported by the industry because of a lack of efficacy or problematic side effects, including suicidal behaviors. Meta-analyses revealed no data supporting the use of SSRIs, except for fluoxetine. To formulate recommendations for clinical practice, it is necessary to examine specific issues such as (1) the link between SSRIs, depression and suicidal risk; (2) SSRI age-related specific effects, and (3) the high placebo response in child and adolescent depression.

An SSRI prescription is still a second-line option in severe and resistant forms of youth depression. However, in children and adolescents only specialists well trained in child and adolescent psychiatry should prescribe SSRIs.

http://www.medicalnewstoday.com/medicalnews.php?newsid=59707

编辑：蓝色幻想