Antidepressant Safety in Kids Study

The Antidepressant Safety in Kids (ASK) study is part of the Child and Adolescent Psychiatry Trials Network (CAPTN). Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) medications are prescribed to approximately 2 to 3% of American children. Evidence suggests that these medications are beneficial for treating obsessive-compulsive disorder (OCD), anxiety disorders, and major depressive disorder. Following hearings in February and September of 2004, the FDA mandated Black Box warnings for all antidepressants, cautioning prescribers about the risk of treatment-emergent suicidal tendency in children and adolescents treated with these drugs. Although prescribing waned somewhat following the warning, many children continue to receive SSRIs and SNRIs for a variety of conditions that do not have empirically validated alternative treatments. Therefore, there is a pressing need to clearly understand the safety, tolerability, and effectiveness of SSRIs and SNRIs in children and adolescents. Specific Aim: The purpose of this study is to evaluate the safety, tolerability, and effectiveness of SSRI and SNRI medications for children and adolescents with anxiety disorders, depressive disorders, eating disorders, or obsessive-compulsive disorder. The study will characterize predictors of outcome, including demographic, disease severity, comorbidity, concomitant treatment, and genetic variation. This information will help clinicians to better understand the balance of risk and benefit associated with antidepressants and to answer the question of which treatment is best for which child. Three specific aims include the following: 1. To evaluate the within-subject benefit of antidepressant treatment over acute (12 weeks) and maintenance (an additional 6 months) of treatment; 2. To evaluate the adverse event profile for harm to self, harm to others, and psychiatric and nonpsychiatric adverse events; 3. To evaluate potential moderators and mediators of benefits and adverse events. Design: This will be a prospective longitudinal cohort study of 2,420 consecutively enrolled patients who are prescribed an SSRI or SNRI (Citalopram \[Celexa\], Escitalopram \[Lexapro\], Fluoxetine \[Prozac/Prozac Weekly\], Fluvoxamine \[Luvox\], Paroxetine, \[Paxil/Paxil-Cr\], Sertraline \[Zoloft\], Venlafaxine \[Effexor/Effexor XR\], Duloxetine \[Cymbalta\]). Patients will be drawn from the practices of approximately 200 CAPTN participants in the United States and Canada. Study Timeline: This study will have two phases: 1) an acute treatment phase following initiation of treatment with any SSRI or SNRI of the clinician's choosing and 2) a long-term follow-up phase. The acute treatment phase will last 12 weeks and the long-term follow-up phase will occur 6 and 9 months after initiation of treatment. Treatment: Flexible upward titration of any of the commercially available SSRI or SNRI medications. As decided by the treating doctor, titration will depend on the severity of illness, degree of response, and adverse event profile. With few exceptions, concomitant treatments are permitted. Assessment: Study assessment milestones will occur at baseline, Week 12, and Months 6 and 9 or at study entry. CAPTN uses a "no query rule" electronic data capture system. The parent and child will complete a pen and paper workbook consisting primarily of the DISC Predictive Scales (DPS-IV) and the Pediatric Adverse Event Rating Scale (PAERS). Based on this information and on clinical interview, the treating clinician will complete the fully web-based EDC modules at baseline and at all treatment and end-of-study visits.