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Adderall or ritalin better than the placebo in all children. However, the effects were greater in children whose symptoms were more severe (the P-value for this was 1.33).
Predictor
A study comparing the effects on outcomes of a placebo, paroxetine, and citalopram in children who were initially being treated with oral contraceptives (i.e., placebo and paroxetine citalopram) found that the appeared to be equally effective at reducing the rate of relapses. However, citalopram caused a reduction in the relative risk of relapse and severity the placebo did not.
Dose
In children with moderate to severe mood disorder, an increased number of studies compared low doses risperidone (0.375 to 0.625 mg daily), bupropion (0.25 to 0.5 mg daily), or a combination of doses. The most common dose was 0.4 mg daily.
Efficacy
The efficacy of risperidone and fluoxetine in children with depression was assessed in the treatment of mood disorders using one two primary efficacy endpoints. The endpoints are percentage of patients reporting at least partial remission and the percentage of patients reporting remission at week 24, generic drugstore business defined as having a score of ≤12 on the Hospital Anxiety and Depression Scale (HADS-21).
Efficacy of citalopram in mood disorders was assessed using the HADS-21 score as primary efficacy endpoint. Patients had a response rate of 67% for the HADS-21 in children and an overall reduction in the score of 37% after 12 weeks treatment with paroxetine, bupropion, a combination of citalopram and bupropion, or a placebo.
Efficacy of the combination citalopram and fluoxetine was assessed with response to medication as the primary efficacy endpoint and HADS-21 total response.
Safety
Adverse events occurred in 4 of 18,000 patients treated for 1 week and in 0 of 5,000 patients treated for 3 weeks but were not statistically significant compared with placebo. However, the number of discontinuations after remission in patients who had at least partial response to treatment was greater in the citalopram than either of other agents when compared with placebo groups (8 remission and 7 with partial remission).
Tolerability
The greatest difficulty of treatment with citalopram in patients depression is to obtain adequate symptom control, which may necessitate switching agents from week to and/or adding different medications. The greatest difficulty that occurs with citalopram therapy in children is with drowsiness (sleepiness) and difficulty in swallowing the medications, which reduces their dosage and results in them being missed by children.
Long-term Safety and Improvement of Function
There were no serious adverse events reported after 12 weeks of treatment with either for children depression or with comorbid mood disorders who remained with their treatment program for at least one year as shown in the safety reviews.
In a study of adult depression that followed patients for an average of 13 years, the overall rate of serious adverse events was low (0.9%) Difen 25mg $36.25 - $0.4 Per pill and the proportion of patients who discontinued treatment due to adverse events was low (0.7%) in the group who received combination of citalopram and fluoxetine. the 22 patients who developed symptoms that required hospitalization, 12 discontinued treatment without a serious adverse event (Table 3).
Table 3. Serious Adverse Events in the Elderly on Antidepressant Treatment with Fluoxet.
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