Twenty years of progress in paediatric psychopharmacology: accomplishments and unmet needs
Open accessAbstract
The systematic assessment of the efficacy and safety of psychiatric medications in children and adolescents started about 20 years ago. Since then, a considerable number of randomised clinical trials have been conducted, including also a series of publicly funded comparative effectiveness studies to evaluate the therapeutic benefit of medications relative to psychosocial interventions, alone or combined with medications. On the whole, these studies have been informative of the paediatric pharmacokinetics, efficacy and safety of the most commonly used psychotropics. As a consequence, a number of meta-analyses have been conducted that have documented both the benefits and harms of the most common medication groups, such as stimulants, antidepressants and antipsychotics. Evidence-based practice guidelines have been produced, and clinicians can now better estimate the therapeutic value and the risk of treatment, at least at the group mean level. However, most clinical trials have been conducted in research settings, and this limits the generalisability of the results. There is a need for evaluating treatment effects under usual practice conditions, through practical trials. The ongoing debate about the proper role of pharmacotherapy in child mental health can be advanced by comparative effectiveness research to assess the benefit/risk ratio of pharmacotherapy vis-à-vis alternative treatment modalities. In addition, analyses of large population databases can better inform on the impact of early treatment on important distal outcomes, such as interpersonal functioning, social and occupational status, quality of life and risk for disability or mortality. Thus far, paediatric psychopharmacology has been mostly the application to children of medications that were serendipitously discovered and developed for adults. By focusing on the neurobiological mechanisms of child psychopathology, it may be possible to identify more precise pharmacological targets and arrive at a truly developmental psychopharmacology.
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In young people, venlafaxine is linked to a significantly higher risk of suicidal behaviour or ideation.
“We found that venlafaxine had a significantly increased risk for suicidality (suicidal behaviour or ideation) for young people, which is in line with previous reviews.10,11”
Some antidepressants may raise the risk of suicidality.
“Previous metaanalyses 10,11 have shown that anti depres sants, except for fluoxetine, do not offer a clear advantage over pill placebo for many individuals, and some antidepressants might increase risk of suicidality.”
Prior meta-analyses found that, apart from fluoxetine, antidepressants did not clearly outperform pill placebo for many young patients.
“Previous metaanalyses 10,11 have shown that anti depres sants, except for fluoxetine, do not offer a clear advantage over pill placebo for many individuals, and some antidepressants might increase risk of suicidality.”
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- Authors
- Vitiello, B., & Davico, C.
- Affiliations
- Ospedale Regina Margherita (IT)
- University of Turin (IT)
- Corresponding author
- Vitiello, Benedetto
- Venue
- Evidence Based Mental Health
- Publisher
- BMJ
- Published
- 2018-10-23
- Volume
- 21
- Issue
- 4
- Pages
- e10-e10
- ISSN
- 1362-0347 (ISSN-L)
- 1468-960X
- PMC
- PMC10270463
- OpenAlex
- W2897124309
- Cited by
- 21
- References
- 58
- Citations by year
- 2026: 3 · 2024: 1 · 2023: 3 · 2022: 8 · 2020: 3 · 2019: 2 · 2018: 1
- FWCI
- 0.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Evidence-Based Mental Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- child and adolescent mental health, comparative effectiveness research, psychotropic drugs, stimulants, antidepressants, antipsychotic drugs, psychosocial interventions, treatment efficacy and safety, evidence-based recommendations, pragmatic trials, long-term outcomes
- MeSH terms
- Child, Clinical Trials as Topic, Humans, Pediatrics, Psychopharmacology, Psychotropic Drugs, Outcome Assessment, Health Care
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