ABSTRACT
OBJECTIVE: To characterize the adverse effects of treatment with selective serotonin reuptake inhibitors (SSRIs) started in children under age 7 yr. METHODS: We conducted a retrospective review of medical records for all children who had begun treatment with an SSRI under age 7 at an academic psychiatry department in Boston. RESULTS: Thirty-nine children (26 males, 13 females) met the inclusion criteria. Mean age at start of treatment was 5.9 +/- 0.8 yr, and median treatment duration was 5.0 months. The target diagnoses for SSRI treatment were anxiety disorders in 54%, depressive disorders in 23%, and both anxiety and depressive disorders in 20% of patients. There were no reports of suicidal ideation or attempt. No children were medically or psychiatrically hospitalized for adverse effects (AEs). Eleven patients (28%) reported an AE of at least moderate severity; 7 (18%) discontinued the SSRI due to the AE. Six patients discontinued due to behavioral activation and 1 due to gastrointestinal upset. The median time to onset of an AE was 23 days, and median resolution was 19 days from onset. CONCLUSIONS: The high rate of adverse effects, especially activation, in this sample argues for continued caution in using SSRIs in young children. Controlled trials are warranted.
Subject(s)
Mental Disorders/drug therapy , Selective Serotonin Reuptake Inhibitors/adverse effects , Affective Symptoms/chemically induced , Age Factors , Aggression/drug effects , Child , Child, Preschool , Female , Gastrointestinal Diseases/chemically induced , Genetic Predisposition to Disease , Humans , Hyperkinesis/chemically induced , Male , Mental Disorders/genetics , Retrospective StudiesABSTRACT
This case report describes the successful treatment of severe self-injurious behavior in a 16-year-old adolescent with Tourette's disorder and obsessive-compulsive disorder. Treatment is described from initial presentation to the emergency department for severe self-inflicted oral lacerations through discharge from the inpatient psychiatric service. Modes of treatment included emergent medical intervention, intensive care services, psychopharmacology, and psychological services. The collection of treatment modalities implemented by this multidisciplinary team may serve as a guide to other health care professionals when severe self-injurious behavior is the presenting problem.
