What precautions should be taken when prescribing medications for the treatment of anorexia nervosa in children?

Updated: Jun 10, 2019
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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Use appropriate caution when considering treatment with SSRIs in the pediatric population. In December 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) issued an advisory that most SSRIs are not suitable for use by persons younger than 18 years for treatment of "depressive illness." After review, this agency decided that the risks to pediatric patients outweigh the benefits of treatment with SSRIs, except fluoxetine, which appears to have a positive risk-benefit ratio in the treatment of depressive illness in patients younger than 18 years.

In October 2003, the US Food and Drug Administration (FDA) issued a public health advisory regarding reports of suicidality (ideation and attempts) in pediatric patients being treated with antidepressant medications for major depressive disorder and other conditions. The FDA asked, however, that additional studies be performed because suicidality occurred in treated and untreated patients with major depression and thus could not be definitively linked to drug treatment.

In 2005, the FDA proposed that manufacturers change antidepressant labeling by adding a black-box warning regarding the increased suicidality risk in children and adolescents who use antidepressants. The labeling change also emphasized the need for appropriate monitoring and patient awareness via medication guides. Two years later, the FDA also recommended updates on the black-box labeling of antidepressants regarding increased risk of suicidality in young adults aged 18-24 during initial treatment (generally the first 1-2 months).

A cohort study looked at suicide risk for youths younger than 24 years in the context of use of SSRIs and SNRIs and the current “Black Box” warning regarding increased risk of suicidal ideation in this population. [134] This retrospective cohort study included 36,842 children aged 6-18 years enrolled in Tennessee Medicaid from 1995-2006 who were new users of 1 of the antidepressant medications of interest (defined as filling no prescriptions for antidepressants in the preceding 365 days). It found that there was increased risk for suicide attempts among users of multiple antidepressants concomitantly; however, there was no evidence that risk of suicide attempts increased when one medication was prescribed and the adjusted rate of suicide attempts did not differ significantly among current users of SSRI and SNRI antidepressants compared with current users of fluoxetine.

The current evidence does not support an increased risk of suicide in patients with obsessive-compulsive disorder or other anxiety disorders who are treated with SSRIs.

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