Escitalopram: Age Appears Relevant
Escitalopram failed to significantly improve the symptoms of depression in children aged 6–11 years, but it did appear to improve symptoms in children aged 12–17 years, wrote Dr. Karen Dineen Wagner of the University of Texas, Galveston, and her colleagues.
The study included 264 children and adolescents aged 6–17 years who had been diagnosed with major depressive disorder. The Children's Depression Rating Scale-Revised (CDRS-R) served as the primary outcome measure (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:280–8).
The patients received either a placebo or 10 mg/day of escitalopram (Lexapro) for the first 4 weeks, with the option to increase the dosage up to 20 mg/day for the next 4 weeks, depending on the patient's response to the medication and tolerance.
Overall, the average changes in scores on the CDRS-R from baseline were not significantly different among the 102 escitalopram patients and 115 placebo patients who completed the study (−21.9 vs. −20.2).
However, a later analysis that adjusted for age group revealed significant improvements in CDRS-R scores from baseline among the 77 children aged 12–17 years who took escitalopram, compared with the 80 children aged 12–17 years who took a placebo, based on observed cases (−22.3 vs. −17.8).
In addition, adolescents in the escitalopram group showed significant improvements in symptoms based on several secondary outcome measures, including the Clinical Global Impressions-Severity scale.
Headaches and abdominal pain were the only reported adverse events that occurred in more than 10% of patients in either group, and the discontinuation rate in both groups was 1.5%.
The study was supported by Forest Laboratories, one of many companies from which Dr. Wagner has received research support.
Quetiapine May Ease Mania in Teens
Quetiapine was at least as effective as divalproex in alleviating manic symptoms in adolescents in a randomized, double-blind pilot study, wrote Dr. Melissa P. DelBello and her colleagues at the University of Cincinnati, Ohio.
The 28-day pilot study of 50 adolescents aged 12–18 years was the first known to directly compare an atypical antipsychotic with an antiepileptic in adolescents with mania, the researchers noted (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:305–13).
The study was supported by a grant from AstraZeneca Pharmaceuticals, which markets quetiapine (Seroquel), and is one of the many companies from which Dr. DelBello has received research funding.
The adolescents who received quetiapine started with a 100-mg dose on the first day, which was increased to 400 mg by days 4–7, up to a maximum of 600 mg/day. Those who received divalproex started with a 20-mg/kg dose on the first day, which was increased to achieve serum valproic acid levels of 80–120 μg/mL. At the end of the study, the mean doses were 412 mg/day to 422 mg/day in the quetiapine group, and a valproic acid level of 101 μg/mL in the divalproex group.
Overall, patients in both groups showed statistically significant improvements in their scores on the Young Mania Rating Scale at the end of the study, compared with their baseline scores. However, the response was quicker among the quetiapine patients, compared with divalproex patients, and the overall response rate on the Clinical Global Impressions-Bipolar Version-Improvement scale was significantly greater in the quetiapine group, compared with the divalproex group (72% vs. 40%).
Both medications were well tolerated, and no patient in either group withdrew because of adverse effects. There were no significant differences between the treatment groups in terms of age, gender, race, or age of onset of bipolar disorder.
Depression and Violence
Girls who display depressive symptoms during adolescence are at increased risk for physical violence at the hands of their intimate partners, reported Jocelyn A. Lehrer, Sc.D., of the University of California, San Francisco and her colleagues.
The investigators analyzed interview data from 1,659 girls in grades 7–12 at 80 high schools and 52 middle schools in the United States.
The data were part of the National Longitudinal Study of Adolescent Health, and the girls participated in three waves of at-home interviews; the second wave was 1 year after the first, and the third was 5–6 years after the second (Arch. Pediatr. Adolesc. Med. 2006;160:270–6).
Overall, 28% of girls who reported high levels of depression at baseline also reported some type of intimate partner violence within the past year at the third wave follow-up interview, compared with 17.5% of girls with lower levels of depressive symptoms. High levels of depression were defined as scores of 23 or higher on the Center for Epidemiologic Studies Depression Scale, and the incidence of violence was assessed using self-administered questionnaires.