Selective serotonin reuptake inhibitors (
SSRIs) have been used increasingly since the early 1990s to treat
anxiety disorders and depression in children and adolescents. Several recent reports, however, cast doubt on their efficacy and especially raise questions about their role in serious adverse effects (increase in suicidal ideation and suicide attempts as well as reactions involving irritability, hostility, self-harm and self-destructive actions). The efficacy of
SSRIs (
fluoxetine,
sertraline,
fluvoxamine,
paroxetine) in the treatment of
obsessive-compulsive disorders in this population is clear today, although their effects are globally relatively modest.
SSRIs remain notably less effective than
clomipramine for this indication, although a variety of factors (age, family history, and psychiatric comorbidity) are also likely to influence response to treatment. Only several placebo-controlled studies suggest that the
SSRIs (
fluoxetine,
sertraline and
fluvoxamine) may have some utility in the treatment of
anxiety disorders (generalized
anxiety, separation anxiety, social
phobias) in children and teens. The additional benefits from
SSRIs for this indication nonetheless require confirmation.
Imipramine and related
tricyclic antidepressants are ineffective in the treatment of
depressive disorders in children and adolescents. Among the
SSRIs, only
fluoxetine has proven its efficacy for this indication, although its effect here too appears relatively modest. The efficacy of
sertraline and
paroxetine cannot be considered more than probable, requiring confirmation, and that of
citalopram has not been demonstrated. Moreover, because of the risk of suicidal behavior observed in some studies,
SSRIs are inadvisable for the treatment of
depressive disorders in this population. Overall, although the currently available data show
SSRIs to be moderately effective and useful in treating
anxiety disorders and depression in children and adolescents, future studies must focus on more precise identification of their indications, especially relative to psychotherapeutic strategies, which are still considered to be the first-line treatment in these disorders. From a legal point of view, only
sertraline has been authorized in France for the treatment of
obsessive-compulsive disorders in this population.