The place of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depressive disorders in children and adolescents. Recommendations of the Main Board of the Polish Psychiatric Association. Part 1 - Clinical efficacy and areas of application

In the adult population of patients with major depression, both psychotherapeutic and pharmacological interventions are effective, but antidepressants remain the mainstay of treatment. In the case of child and adolescent psychiatry, there is still controversy over whether to use pharmacological interventions and which drug to prefer. Although psychotherapeutic treatment is still considered a first-line treatment, antidepressants are widely used to treat depression in children and adolescents, and the number of medications prescribed for this indication has increased over time. In Poland, about 57,000 patients under 18 years of age currently use reimbursed antidepressants. Antidepressants are generally effective and well tolerated by children, but between 31% and 48% will not respond to them and up to 25% will experience side effects. The aim of the study was to present the effectiveness and tolerance of antidepressants used in depression in the pediatric population. Among all SSRIs, the largest amount of data from short-term RCTs and their meta-analyses indicate the effectiveness of fluoxetine in patients diagnosed with depression < 18 years of age. which still makes it the drug of first choice in this indication. However, the results of meta-analyses do not allow to draw clear conclusions as to the effectiveness of individual SSRIs in the treatment of depression in children and adolescents. Single placebo-controlled studies show the efficacy of sertraline, escitalopram and citalopram in the treatment of depression in patients <18 years of age, making them important treatment options worth considering. There is no reliable evidence on the effectiveness of fluvoxamine.