Pharmacologic treatment of adolescent depression

Depression is a disease entity that causes significant morbidity and mortality in the adolescent population. It is important for primary care providers to recognize the signs and symptoms associated with depression in adolescents. This article discusses the current literature addressing the pharmacologic treatment of adolescent depression. A brief review of diagnosing depression is included. Diagnosis of depression in the adolescent with normal and abnormal development is examined, along with risk factors associated with increased incidence of depression in this population. Past and present clinical trials of tricyclic, monoamine oxidase inhibitor, and selective serotonin reuptake inhibitor classes of antidepressants are reviewed. In addition, adverse effects and toxicity are briefly discussed. Currently, the selective serotonin reuptake inhibitors are the first-line pharmacologic intervention for adolescent depression, although only selected drugs have undergone controlled clinical trials in this age group. The high toxicity profile of other classes of antidepressants makes their choice less optimal. Newer antidepressants have also been studied recently in the adolescent population. Further pharmacotherapy research in this vulnerable cohort is needed.