From the Guidelines
Before prescribing selective serotonin reuptake inhibitors (SSRIs) to an adolescent, no specific laboratory test is required, as there is no clear role for pharmacogenomic testing or other laboratory tests in medication selection, according to the most recent evidence 1. The primary consideration is:
- Monitoring for suicidal thinking and behavior, as all SSRIs have a boxed warning for this potential adverse effect through age 24 years 1. Additional considerations include:
- Close monitoring for behavioral activation/agitation, particularly in younger children, and educating parents/guardians and patients about this potential side effect 1.
- Caution when combining SSRIs with other serotonergic medications, as this can increase the risk of serotonin syndrome 1. These considerations are important because SSRIs can have significant adverse effects, and close monitoring is necessary to ensure the patient's safety. The evidence suggests that SSRIs are generally well tolerated by children and adolescents, but potentially serious adverse effects can occur, including suicidal thinking and behavior, behavioral activation/agitation, and serotonin syndrome 1. It's crucial to carefully weigh the potential benefits and risks of SSRI treatment and to closely monitor the patient's health during treatment, rather than relying on specific laboratory tests before initiating treatment.
From the Research
Laboratory Tests Before Prescribing SSRIs
There are no specific laboratory tests required before prescribing selective serotonin reuptake inhibitors (SSRIs) to an adolescent, as the decision to prescribe is typically based on a comprehensive diagnostic evaluation and clinical judgment 2, 3, 4, 5, 6.
Considerations for Prescribing SSRIs
- The efficacy and safety of SSRIs in children and adolescents have been studied, with some SSRIs showing moderate effectiveness in treating anxiety disorders and depression 2, 3, 5.
- However, the use of SSRIs in adolescents is not without risks, including the potential for suicidal behavior and other adverse effects 2, 4, 5.
- Clinicians should carefully weigh the potential benefits and risks of SSRI treatment and consider alternative therapies, such as cognitive-behavioral therapy, before initiating treatment 4.
- Regular monitoring of the patient's response to treatment, compliance, and side effects is crucial to ensure safe and effective use of SSRIs 3, 4.
Specific SSRIs and Their Efficacy
- Fluoxetine is the only SSRI that has proven efficacy for the treatment of depression in adolescents 2, 4.
- Sertraline and paroxetine may have some utility in treating anxiety disorders in children and teens, but their efficacy requires further confirmation 2, 3.
- The efficacy of citalopram has not been demonstrated in adolescents 2.