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Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression
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Discontinuation, Medication Switching, and Augmentation After SSRI in Pediatric Depression.

Haeyoung Lee1, Wendy Camelo Castillo1, Danya M Qato2

  • 1School of Pharmacy, University of Maryland, Baltimore, Maryland.

Journal of the American Academy of Child and Adolescent Psychiatry
|June 17, 2026
PubMed
Summary

Over half of children and adolescents with depression do not continue their initial antidepressant treatment past 12 weeks. Factors like older age and substance use increase the risk of changing medication regimens.

Keywords:
antidepressantdiscontinuationpediatric depressionregimen changeswitch augmentation

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Area of Science:

  • Child and Adolescent Psychiatry
  • Pharmacotherapy
  • Mental Health Research

Background:

  • Depression is a significant mental health concern in children and adolescents.
  • Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed first-line antidepressants.
  • Understanding treatment adherence and regimen changes is crucial for optimizing care.

Purpose of the Study:

  • To investigate antidepressant regimen changes after an initial selective serotonin reuptake inhibitor (SSRI) trial in pediatric depression.
  • To identify factors associated with antidepressant regimen modification in this population.

Main Methods:

  • Population-based cohort study using the IQVIA PharMetrics® Plus database (2010-2022).
  • Included children and adolescents (8-18 years) initiating SSRI monotherapy.
  • Cox proportional hazards regression analyzed factors associated with regimen change after 12 weeks.

Main Results:

  • Over half (53.4%) of 20,708 individuals changed their antidepressant regimen after 12 weeks.
  • Discontinuation (45.2%) was the most common change, followed by switching (5.5%) and augmentation (2.7%).
  • Older age, substance use disorder, psychiatric hospitalization, and ED visits increased regimen change risk; anxiety disorder and psychotherapy decreased it.

Conclusions:

  • More than half of children and adolescents do not continue their initial antidepressant treatment beyond 12 weeks.
  • Treatment adherence and regimen stability are significant challenges in pediatric depression pharmacotherapy.
  • Identifying associated factors can inform strategies to improve treatment continuity.