SEÇİCİ SEROTONİN GERİ ALIM İNHİBİTÖRLERİYLE TEDAVİ EDİLEN ÇOCUK VE ERGENLERDE YAN ETKİLERİN SIKLIĞI VE İLİŞKİLİ FAKTÖRLER: BİR DOSYA TARAMA ÇALIŞMASI

Yıl 2023, Cilt: 86 Sayı: 1, 28 - 36, 31.01.2023

Hanım Hülya Alınay , Ali Karayağmurlu , Murat Coşkun

https://doi.org/10.26650/IUITFD.1153370

Öz

Amaç: Bu çalışma, seçici serotonin geri alım inhibitörü (SSRI) monoterapisi alan genç hastalar arasında ilaç yan etki sıklığını ve bu yan etkilerle ilişkili klinik ve sosyodemografik faktörleri incelemeyi amaçlamaktadır. Gereç ve Yöntem: Bir üniversite hastanesinin çocuk ve ergen psikiyatrisi kliniklerinde SSRI monoterapisi alan 85 hastanın tıbbi kayıtları incelendi. Dahil edilme kriterlerini karşılayan hastalar çalışmaya dahil edildi. Bulgular: Toplam 67 hasta (10,82±3,63 yıl) dahil edildi. Hastaların yarısından fazlası (n=39, %58,9) muhtemelen SSRI tedavisi ile ilişkili en az bir yan etki geliştirdi. En sık bildirilen yan etkiler; psişik (n=25, %37,3) ve otonomik yan etkilerin (n=20, %29,9) yanısıra davranışsal aktivasyondu (n=13, %19,4). Yan etkiler nedeniyle 13 hastada (%19,4) ilaç tedavisi sonlandırıldı ve en sık ilaç kesme nedeni davranışsal aktivasyondu (13 hastanın 6’sı). Davranış aktivasyonunun ortaya çıkması; daha küçük yaş, hastada obsesif kompulsif bozukluk tanısı varlığı ve babada psikiyatrik hastalık varlığı ile anlamlı olarak ilişkiliydi (p değeri<0,05). Sonuç: SSRI’lar genç hastalarda genellikle güvenli ve iyi tolere edilmesine rağmen, yan etkiler sık olabilir ve bazı durumlarda ilacın kesilmesi gerekebilir. Bu nedenle, genç hastaları tedavi eden klinisyenler, özellikle davranışsal aktivasyonun gelişimi konusunda dikkatli olmalıdır. Ayrıca SSRI tedavisi sırasında ortaya çıkabilecek yan etkilerle ilişkili klinik ve sosyodemografik faktörleri de dikkate almalıdırlar.

Anahtar Kelimeler

ergen, yan etki, çocuk, seçici seratonin geri alım inhibitörü, davranışsal aktivasyon

PREVALENCE AND ASSOCIATED FACTORS OF ADVERSE EFFECTS IN CHILDREN AND ADOLESCENTS TREATED WITH SELECTIVE SEROTONIN REUPTAKE INHIBITORS: A CHART REVIEW STUDY

Öz

Objective: This study aims to examine the prevalence and associated clinical and sociodemographic factors of adverse effects in medication among naïve young subjects who received selective serotonin reuptake inhibitor (SSRI) monotherapy. Material and Methods: The medical records of 85 patients who had received SSRI monotherapy in a university hospital’s child and adolescent psychiatry clinic were reviewed. The subjects who met the inclusion criteria were included in the study. Results: A total of 67 subjects (10.82±3.63 years) were included. More than half (n=39, 58.9%) developed at least one adverse effect possibly associated with SSRI treatment, with psychic (n=25, 37.3%) and autonomic (n=20, 29.9%) adverse effects as well as behavioral activation (n=13, 19.4%) being the most frequently reported. Medication was discontinued in 13 subjects (19.4%) due to adverse effects, with behavioral activation (6 out of 13 subjects) being the most frequent reason for discontinuation. The development of behavioral activation was significantly associated with younger age, diagnosis of obsessive compulsive disorder in the subjects, and psychiatric history in the subjects’ fathers (p value<0.05). Conclusions: Despite the fact that SSRIs are generally safe and well-tolerated in young subjects, adverse effects may be frequent, and medication discontinuation may be required under some conditions. Thus, clinicians treating young subjects should be cautious, particularly about the development of behavioral activation. They should also be mindful of the clinical and sociodemographic factors associated with the adverse effects that may arise during SSRI treatment.

Anahtar Kelimeler

adolescents, adverse effects, children, side effects, selective serotonin reuptake inhibitors, behavioral activation

Kaynakça

• 1. Garland EJ, Kutcher S, Virani A, Elbe D. Update on the use of SSRIs and SNRIs with children and adolescents in clinical practice. J Can Acad of Child and Adolesc Psychiatry 2016;25(1):4. google scholar
• 2. Safer DJ, Zito JM. Treatment-emergent adverse events from selective serotonin reuptake inhibitors by age group: children versus adolescents. J Child Adolesc Psychopharmacol 2006;16(1-2):159-69. [CrossRef] google scholar
• 3. Bachmann CJ, Aagaard L, Burcu M, Glaeske G, Kalverdijk LJ, Petersen I, et al. Trends and patterns of antidepressant use in children and adolescents from five western countries, 2005-2012. Eur Neuropsychopharmacol 2016;26(3):411-9. [CrossRef] google scholar
• 4. Pratt LA, Brody DJ, Gu Q. Antidepressant Use among Persons Aged 12 and Over: United States, 2011-2014. NCHS Data Brief 2017;283:1-8. google scholar
• 5. Safer DJ. Age-grouped differences in adverse drug events from psychotropic medication. J Child Adolesc Psychopharmacol 2011;21(4):299-309. [CrossRef] google scholar
• 6. Maruf AA, Greenslade A, Arnold PD, Bousman C. Antidepressant pharmacogenetics in children and young adults: A systematic review. J Affect Disord 2019;254:98-108. [CrossRef] google scholar
• 7. Martin A, Young C, Leckman JF, Mukonoweshuro C, Rosenheck R, Leslie D. Age effects on antidepressant-induced manic conversion. Arch Pediatr Adolesc Med 2004;158(8):773-80. [CrossRef] google scholar
• 8. Garcia-Delgar B, Morer A, Varela E, Romero S, García M, Coffey BJ, et al. Activation in children and adolescents treated with selective serotonin reuptake inhibitors: a weighty reason? J Clin Psychopharmacol 2018;38(5):475-80. [CrossRef] google scholar
• 9. Gordon M, Melvin G. Selective serotonin re-uptake inhibitors: a review of the side effects in adolescents. Aust Fam Physician 2013;42(9):620-3. google scholar
• 10. Emslie G, Kratochvil C, Vitiello B, Silva S, Mayes T, McNulty S, et al. Treatment for Adolescents with Depression Study (TADS): safety results. J Am Acad Child Adolesc Psychiatry 2006;45(12):1440-55. [CrossRef] google scholar
• 11. Guy W. ECDEUassessmentmanual for psychopharmacology: 1976. National Institute of Mental Health, 1976. [CrossRef] google scholar
• 12. Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. The UKU side effect rating scale: a new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl 1987;334:1-100. [CrossRef] google scholar
• 13. Usta H, Ünal GG, Gıca Ş. Udvalg Kliniske Unders0gelserYan Etki Değerlendirme Ölçeği’nin (UKUSERS) kronik şizofreni tanılı hastalarda Türkçe güvenilirlik ve faktör analizi. Yeni Symposium 2020;58 (3);7-10. google scholar
• 14. Reid JM, Storch EA, Murphy TK, Bodzin D, Mutch PJ, Lehmkuhl H, et al. Development and psychometric evaluation of the treatment-emergent activation and suicidality assessment profile. Child Youth Care Forum 2010;39:113-24. [CrossRef] google scholar
• 15. Wilens TE, Biederman J, Kwon A, Chase R, Greenberg L, Mick E, et al. A systematic chart review of the nature of psychiatric adverse events in children and adolescents treated with selective serotonin reuptake inhibitors. J Child Adolesc Psychopharmacol 2003;13(2):143-52. [CrossRef] google scholar
• 16. Coskun M, Zoroglu S. Efficacy and safety of fluoxetine in preschool children with obsessive-compulsive disorder. J Child Adolesc Psychopharmacol 2009; 19:297-300. [CrossRef] google scholar
• 17. Coskun M, Ozturk M, Zoroglu S. Escitalopram treatment in preschool children with anxiety disorders: a case series. Bulletin of Clinical Psychopharmacology 2012;22:262-7. [CrossRef] google scholar
• 18. Coskun M, Zoroglu S, Ozturk M. Risperidone treatment in preschool children with disruptive behavior disorders: A chart review study. Bulletin of Clinical Psychopharmacology 2011;21:33-41. [CrossRef] google scholar
• 19. Coskun M. Aripiprazole monotherapy was effective in treating obsessive-compulsive disorder in a preschool boy. J Clin Psychopharmacol 2017;37(5):636-637. [CrossRef] google scholar
• 20. Coskun M, Karayagmurlu A. Aripiprazole treatment for obsessive compulsive disorder in two young subjects who could not tolerate SSRIs. J Clin Psychopharmacol 2020;40(3):310-2. [CrossRef] google scholar
• 21. Coskun M, Güven G, Alnak A, Karayağmurlu A. Psychiatric comorbidity and sleep problems in children and adolescents with ADHD in relation to ADHD presentation, age and gender. J Ist Faculty Med 2020;83(4):363-72. [CrossRef] google scholar
• 22. Carlson GA, Mick E. Drug-induced disinhibition in psychiatrically hospitalized children. J Child Adolesc Psychopharmacol 2003;13(2):153-63. [CrossRef] google scholar
• 23. Murrin LC, Sanders JD, Bylund DB. Comparison of the maturation of the adrenergic and serotonergic neurotransmitter systems in the brain: implications for differential drug effects on juveniles and adults. Biochem Pharmacol 2007;73(8):1225-36. [CrossRef] google scholar
• 24. Qin B, Zhang Y, Zhou X, Cheng P, Liu Y, Chen J, et al. Selective serotonin reuptake inhibitors versus tricyclic antidepressants in young patients: a meta-analysis of efficacy and acceptability. Clin Ther 2014;36(7):1087-95. [CrossRef] google scholar
• 25. Strawn JR, Adler CM, McNamara RK, Welge JA, Bitter SM, Mills NP, et al. Antidepressant tolerability in anxious and depressed youth at high risk for bipolar disorder: a prospective naturalistic treatment study. Bipolar Disord 2014;16(5):523-30. [CrossRef] google scholar
• 26. Birmaher B, Axelson DA, Monk K, Kalas C, Clark DB, Ehmann M, et al. Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 2003;42(4):415-23. [CrossRef] google scholar
• 27. Keller MB, Ryan ND, Strober M, Klein RG, Kutcher SP, Birmaher B, et al. Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2001;40(7):762-72. [CrossRef] google scholar
• 28. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 2008;359(26):2753-66. [CrossRef] google scholar
• 29. Melvin GA, Tonge BJ, King NJ, Heyne D, Gordon MS, Klimkeit E. A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression. J Am Acad Child Adolesc Psychiatry 2006;45(10):1151-61. [CrossRef] google scholar
• 30. Strawn JR, Welge JA, Wehry AM, Keeshin B, Rynn MA. Efficacy and tolerability of antidepressants in pediatric anxiety disorders: A systematic review and meta analysis. Depress Anxiety 2015;32(3):149-57. [CrossRef] google scholar
• 31. Dobson ET, Strawn JR. Pharmacotherapy for pediatric generalized anxiety disorder: a systematic evaluation of efficacy, safety and tolerability. Pediatr Drugs 2016;18(1):45-53. [CrossRef] google scholar
• 32. DeVane CL, Sallee FR. Serotonin selective reuptake inhibitors in child and adolescent psychopharmacology: a review of published experience. J Clin Psychiatry 1996;57(2):55-66. google scholar
• 33. Cheung AH, Emslie GJ, Mayes TL. Review of the efficacy and safety of antidepressants in youth depression. J Child Psychol Psychiatry 2005;46(7):735-54. [CrossRef] google scholar
• 34. Reinblatt SP, Riddle MA. Selective serotonin reuptake inhibitor-induced apathy: a pediatric case series. J Child Adolesc Psychopharmacol 2006;16:227-33. [CrossRef] google scholar
• 35. Goodyer IM, Wilkinson PO. Practitioner Review: Therapeutics of unipolar major depressions in adolescents. J Child Psychol Psychiatry 2019;60(3):232-43. [CrossRef] google scholar
• 36. S0rensen J0, Rasmussen A, Roesbjerg T, Pagsberg AK. Clinician compliance to recommendations regarding the risk of suicidality with selective serotonin reuptake inhibitors in the treatment of children and adolescents. Eur Child Adolesc Psychiatry 2020;29(5):707-18. [CrossRef] google scholar
• 37. Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord 2000;58(1):19-36. [CrossRef] google scholar
• 38. Usala T, Clavenna A, Zuddas A, Bonati M. Randomised controlled trials of selective serotonin reuptake inhibitors in treating depression in children and adolescents: a systematic review and meta-analysis. Eur neuropsychopharmacol 2008;18(1):62-73. [CrossRef] google scholar
• 39. Luft MJ, Lamy M, DelBello MP, McNamara RK, Strawn JR. Antidepressant-induced activation in children and adolescents: risk, recognition and management. Curr Probl Pediatr Adolesc Health Care 2018;48(2):50-62. [CrossRef] google scholar
• 40. Reinblatt SP, Dosreis S, Walkup JT, Riddle MA. Activation adverse events induced by the selective serotonin reuptake inhibitor fluvoxamine in children and adolescents. J child adolesc psychopharmacol 2009;19(2):119-26. [CrossRef] google scholar