Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial.

OBJECTIVE: To compare paroxetine with placebo and imipramine with placebo for the treatment of adolescent depression. METHOD: After a 7- to 14-day screening period, 275 adolescents with major depression began 8 weeks of double-blind paroxetine (20-40 mg), imipramine (gradual upward titration to 200-300 mg), or placebo. The two primary outcome measures were endpoint response (Hamilton Rating Scale for Depression [HAM-D] score < or = 8 or > or = 50% reduction in baseline HAM-D) and change from baseline HAM-D score. Other depression-related variables were (1) HAM-D depressed mood item; (2) depression item of the Schedule for Affective Disorders and Schizophrenia for Adolescents-Lifetime version (K-SADS-L); (3) Clinical Global Impression (CGI) improvement scores of 1 or 2; (4) nine-item depression subscale of K-SADS-L; and (5) mean CGI improvement scores. RESULTS: Paroxetine demonstrated significantly greater improvement compared with placebo in HAM-D total score < or = 8, HAM-D depressed mood item, K-SADS-L depressed mood item, and CGI score of 1 or 2. The response to imipramine was not significantly different from placebo for any measure. Neither paroxetine nor imipramine differed significantly from placebo on parent- or self-rating measures. Withdrawal rates for adverse effects were 9.7% and 6.9% for paroxetine and placebo, respectively. Of 31.5% of subjects stopping imipramine therapy because of adverse effects, nearly one third did so because of adverse cardiovascular effects. CONCLUSIONS: Paroxetine is generally well tolerated and effective for major depression in adolescents.

Comparison of lithium dosage methods for preschool- and early school-age children.

OBJECTIVE: Lithium may be useful in the treatment of prepubertal children with bipolar disorder or aggressive conduct disorder. However, there are few dosage guidelines. This study compares two dosage methods reported for prescribing lithium to prepubertal children: (1) a weight-based dosing schedule and (2) a single-dose, kinetics-based method. METHOD: Lithium doses were calculated using each method and then compared with doses actually used in the clinical care of hospitalized children. RESULTS: No statistically significant differences were found between mean lithium dose estimates calculated by the two methods. Average lithium dose estimates for both kinetic and weight-based methods were less than the observed discharge doses. Differences were seen between the two methods for children weighing between 25 and 30 kg. CONCLUSIONS: The weight-based dosing schedule and the single-dose, kinetics-based methods for calculating lithium dose result in similar dosage estimates when applied to young children.

Case study: hypersomnolence and precocious puberty in a child with pica and chronic lead intoxication.

The limited literature on hypersomnolence suggests that it is a poorly defined symptom associated with a spectrum of disorders from monosymptomatic hypersomnolence to the Kleine-Levin syndrome. These disorders often herald an organic central nervous system syndrome. Recent evidence suggests a frequent association between these disorders and hypothalamic dysfunction, which itself may be caused by a variety of factors. This case study of a patient with persistent hypersomnolence, hypothalamic dysfunction (in the form of precocious puberty), pica, and chronic lead intoxication strengthens the association between hypersomnolence and hypothalamic dysfunction and suggests a heretofore unreported cause of hypothalamic dysfunction in humans.

Untoward effects of lithium treatment in children aged four through six years.

OBJECTIVE: To explore the relationship between lithium dose and serum lithium level on the occurrence of untoward or toxic effects of lithium in the treatment of 20 hospitalized aggressive and/or mood-disordered children aged 4 through 6 years. METHOD: Clinical and research records of 20 children treated with lithium according to an established inpatient protocol were reviewed. Side effects as reported by psychiatric staff were categorized by organ system affected and severity. RESULTS: During the initial 2 weeks of lithium treatment, 60% of the children manifested one or more types of side effects, most commonly central nervous system effects. Side effects were seen at doses of 25.6 to 52.1 mg/kg per day and at serum levels from 0.65 to 1.37 mEq/L. In general, adverse effects were associated with higher lithium doses and lithium levels and were most common during the first week of treatment. A potential interaction between concurrent infection and more severe side effects was seen. CONCLUSIONS: Side effects occur frequently in children aged 6 years and younger during the initiation phase of lithium treatment; are related to higher milligram per kilogram doses, higher serum lithium levels, and phase of treatment; and may be related to concurrent medical illness.