Antidepressant therapy in first-time patients hospitalized in a child and adolescent psychiatry ward with a depressive episode

Background. Paediatric depression typically presents in primary care and is undertreated. This may lead to acute hospitalization. A selective serotonin reuptake inhibitor (SSRI) is the first-line pharmacological treatment. Fluoxetine has been more widely studied in children and adolescents. Literature data suggest that paediatric depression doubled during the first year of the COVID-19 pandemic.
Aim. The aim of this study was to compare hospitalized patients’ treatment with antidepressants before their hospitalization and during hospitalization from 2016 to 2021 and evaluate the association between the COVID-19 pandemic and changes in hospitalization rates of these patients.
Methods. Altogether 183 patients’ data were analysed, divided into two time periods: pre- and intra- pandemic (2016–2019; 2020–2021). The study included patients with a depressive episode (F32) who were admitted to a child and adolescent inpatient ward for the first time in their lives and spent there more than one day. Data were obtained from the Children’s Clinical University Hospital’s information systems. All data were analysed using IBM SPSS v26.0 and Excel 2020.
Results. From all patients 11% (n=21) were boys and 89% (n=162) were girls. The mean age was 14.5 years (SD=1.7). The mean length of stay was 17 days (SD=10). Half (51%, n=94) of patients were treated before hospitalization; 63% (n=59) of them received only one antidepressant (AD): 37% (n=22) received sertraline; 15% (n=15), fluoxetine; and 24% (n=14), fluvoxamine. Non-specific side effects occurred in 9% (n=8) of patients. During hospitalization 84% (n=154) of patients were treated with ADs. 79% (n=121) of them received only one AD. Fluoxetine was the first choice in 40% (n=62) of patients; sertraline, 25% (n=38); and fluvoxamine, 23% (n=35). Less than one-third (28%, n=26) of patients had their AD switched due to side effects or lack of effectiveness. Hyperprolactinemia occurred in 7% (n=7) of patients, 10% (n=9) of patients experienced non-specific side effects. In the pre-pandemic period, 20 patients per year were hospitalized with a depressive episode for the first time in their lives; in the intra-pandemic period, 50 patients per year.
Conclusion. Half of the patients were treated with antidepressants before hospitalization. Before and during hospitalization patients mostly received sertraline and fluoxetine, respectively. The most common specific side effect experienced by hospitalized patients was hyperprolactinemia. During the intra-pandemic period the number of patients with a depressive episode who were hospitalized for the first time increased 2.5 times.
Acknowledgements. The authors declare the absence of conflict of interest.