Do Antidepressants Induce Psychosis in Children and Adolescents? A Naturalistic Study in Ambulatory Pediatric Population.

Objective: The aim of the present study was to examine if selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) induce psychotic symptoms in children and adolescent outpatients. We secondarily aimed to assess the occurrence of adverse events (AE), with particular interest in psychiatric adverse events (PAE), timing of their onset, and the effectiveness of antidepressants in children and adolescents.

Methods: We retrospectively evaluated the computerized medical records of children and adolescents treated with antidepressants (SSRIs or SNRIs) for depressive disorders, anxiety disorders, and obsessive-compulsive disorders. AE and Clinical Global Impressions scores were recorded.

Results: Sixty-nine children and adolescents aged 13.3 ± 3.0 years were included. None of the patients treated presented with acute psychotic symptoms (delusions, hallucinations, and disorganized thinking or behavior). Duration of treatment extended over 13.4 ± 11.8 months. PAE occurred in 39% of cases. Of these, 16% included suicidality (ideations or attempts), and 3% included nonpsychotic hypomanic symptoms. Significant clinical improvement was achieved in 41% of patients.

Conclusions: In contrast to the clinical impression of some clinicians, antidepressant treatment in pediatric ambulatory population was not associated with emergence of psychotic symptoms.