Pharmacology of the selective serotonin reuptake inhibitors in children and adolescents

Objective: To review the pharmacology of a new class of medications, the potent selective serotonin reuptake inhibitors (SSRIs), what is known about their metabolism in children and adolescents, and the practical clinical implications of such. Method: Articles were retrieved through Index Medicus searches for articles published during the past 10 years on the SSRIs and on pediatric pharmacology. Results: More than 300 articles were reviewed. Pharmacological data, derived from relevant adult literature, were summarized and extrapolated to children and from the limited pediatric literature. The SSRIs represent a new class of antidepressants with distinct advantages in their side effect profile and their broad therapeutic index over that seen with the tricyclic antidepressants. Their advantage of few anticholinergic side effects and limited cardiovascular toxicities are particularly relevant for the pediatric population. The SSRIs are metabolized via the hepatic cytochrome isoenzyme P450 system, and potential drug-drug interactions are reviewed. Conclusions: The SSRIs appear to offer advantages over the tricyclic antidepressants. Unfortunately, pharmacokinetic data are lacking, and systematic studies of safety and efficacy in the pediatric age group are limited. Preliminary reports are encouraging, but further study is required.