TORONTO — Antidepressants may provide a small to moderate benefit in improving irritability, disruptive behaviors, and aggression in adolescent patients, results of a poster presented at the American Psychiatric Association Annual Meeting indicate.
“The absence of a diagnostic profile to describe irritability prior to disruptive mood dysregulation disorder (DMDD) in DSM-5 has curtailed specific estimates of the prevalence and treatment of irritability,” explained Khrista Boylan, MD, of McMaster University in Hamilton, Canada, and colleagues.
To evaluate the efficacy of antidepressants for the treatment of irritability, aggression, and disruptive behaviors in children, the investigators culled data from 11 studies. Only two uncontrolled studied assessed the outcome of irritability. One study involved children with ‘difficult temperament’ exposed to various selective serotonin reuptake inhibitors (SSRIs). The other involved aggressive adolescents exposed to citalopram. Both studies reported significant improvements in irritability after treatment, according to the researchers.
The most robust evidence came from three clinical trials of antidepressant or cognitive-behavioral therapy (CBT) treatment for depression which identified small effect sizes for antidepressant exposure on secondary behavior outcomes.
The scientists reported several limitations on their research. Most studies evaluated irritability as a secondary outcome, a lack of consistency in outcome scales, and a predominately male cohort of patients.
“This review has identified evidence of small to moderate benefit of antidepressant medication for outcomes of irritability, disruptive behaviors and aggression in youth,” concluded the investigators.
“Given the burgeoning literature regarding the place of irritability as a core feature of oppositional defiant disorder, and the clinical utility of the diagnosis of DMDD, more treatment studies are gravely needed for irritable youth.”
Boylan K et al. Effectiveness of Antidepressant Medications for Symptoms of Irritability and Disruptive Behaviours in Children and Adolescents. Poster P5-030. Presented at: APA 2015. May 16-20, 2015; Toronto, Canada.