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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by mk on April 2, 1999, at 13:41:09
TOBY/Other
Professionals: ADVICE
RE ADOLES. DEP.Posted by mk on March 23, 1999, at 16:44:10
Toby: after reviewing this site for the past
few days, I've noticed that you are a
professional
who seems to keep up to date on
psychopharmacology
and actually responds to queries. Hope you
have time to respond to this one.Our problem: 16-yr-old adolescent with
major depression for past 2 months. Zoloft
at 50 for 2 weeks/100 last 2 weeks and 125
last few days. Not getting a therapeutic
result yet on zoloft but is having some
mild fine hand tremors. One dr. says tremors
are not major and should go away and keep
titrating zoloft to higher dosage since
adolescents tend to need higher dosages and
metabolize AD quicker--other dr. says switch
to Celexa. Researched Celexa and can find
no medical studies of its use in adolescents.
Are there any studies of its use with this
age group? We hate to use an unproven drug
with a teenager. Also, do tremors tend to
come from side effects on neurotransmitters
other than serotonine such as mild effects
on dopamine and/or norepinephrine? Or all
all side effects to SSRIs just very
individualistic? It the tremors are likely
to come from specific chemical pathways it
would seem that if we change we would want
to change to a medication with another
pathway.What are the "practice guidelines" for
major depression with perfectionistic anxiety
for
adolescent depression in terms of first line
medications? Note: since the depression,
has been sleepy so don't want an overly
sedating drug. Also, is in Cognitive
Behavioral Therapy which should help long
term but still need some help more immediately
just to get through day to day! Would really,
really appreciate your response.
Posted by Matt on April 3, 1999, at 0:08:13
In reply to TOBY-HOPE YOU CAN RESPOND?, posted by mk on April 2, 1999, at 13:41:09
One can get EPS when first starting on an SSRI or when upping the dose--the likely explanation is that either causes increased serotoninigic activity, resulting in a lowering of DA activity in the striatum. These usually go away once the serotonin receptors have been downregulated. So the doc who says that the tremors will abate probably is correct.
Celexa is new in the US, but it has been used extensively in Europe. I'd be quite surprised if there haven't been studies on its use in adolescents done in Europe.
Matt
Posted by Toby on April 6, 1999, at 11:50:23
In reply to Re: TOBY-HOPE YOU CAN RESPOND?, posted by Matt on April 3, 1999, at 0:08:13
Matt is correct about the tremors usually going away after a steady dose is achieved. Also, the dose is being increased fairly quickly in this case. Antidepressants don't usually kick in until 4-6 weeks of being on a therapeutic dose (for Zoloft that's anywhere between 50-200 mg) so it's not surprising that there hasn't been any real change yet. The general consensus is that a person needs to remain on a therapeutic dose of an antidepressant for 6-10 weeks at least before switching to something else. Sometimes switching to another medication in the same class (Zoloft to Celexa for example, both SSRI's) is beneficial, but usually the recommendation is to try a medication from a different class (like Effexor, Serzone, Remeron, Wellbutrin). Most drug companies aren't going to do extra research on children unless they think they are going to get a special niche to boost sales, so there may not be a lot of research data for you to find, but child psychiatrists are using all the newer antidepressants in teens without any more problems than they see in adults. I would think it would be reasonable to let him stay on the meds at least another 4 weeks (perhaps they may even increase the dose to 150 mg) and if no change in the depresssion has happened at all, to then switch to one of the meds listed above; with the anxious component any of those would be a good choice and also, if the doc wants, he could add one of those meds to the Zoloft without switching first and then if there is a response, gradually taper off the Zoloft.
This is the end of the thread.
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