Focus on the use of antidepressants to treat pediatric functional abdominal pain: current perspectives

Figures & data

Table 1 Selective serotonin reuptake inhibitors

Drug	Commercial name	Indication
Citalopram	Celexa	Depression
Escitaloprama	Lexapro	Depression
Fluoxetinea	Prozac	Depression
Sertraline	Zoloft	Depression
Paroxetine	Paxil, Pexeva	Depression
Vilazodone	Viibryd	Depression
Fluvoxamine	Luvox	Obsessive-compulsive disorder, depression

Note:

a US Food and Drug Administration approved for the treatment of pediatric depression.

Table 2 Tricyclic antidepressants

Drug	Commercial name	Indication
Amitriptyline	Elavil	Depression
Nortriptyline	Pamelor	Depression
Desipramine	Norpramin	Depression
Doxepin	Sinequan	Depression
Imipramine	Tofranil	Depression
Protriptyline	Vivactil	Depression
Trimipramine	Surmontil	Depression

Table 3 Summary of antidepressant studies in children

Study	Study type	Antidepressant	Inclusion criteria	Exclusion criteria	Age, mean years, female %	Adverse effects
Campo et al^Citation28 2004	Open label	Citalopram	Appley’s criteria for RAP	>3 nighttime awakenings for abdominal pain, abnormal EKG, GI bleed, chronic disease, eating disorder	12.2±3.0, 52	Abdominal pain, nausea, diarrhea, heartburn, headache dizziness, sleep difficulties, anger, irritability, nasal congestion, difficulty concentrating
Saps et al^Citation37 2009	RCT	Amitriptyline	Rome II criteria for FAP, FD, IBS	Abnormal EKG, tissue transglutaminase, urinalysis, blood count, erythrocyte sedimentation rate, albumin, pancreatic and liver enzymes, or stool examination	12.7, 73	Drug: fatigue, rash, headaches; Placebo: dizziness
Bahar et al^Citation36 2014	RCT	Amitriptyline	Rome II criteria for IBS	Prolonged QT	14.7, 73	None
Roohafza et al^Citation20	RCT	Citalopram	Rome III criteria for FAP	Psychotropic medications, antibiotics, or probiotics use in the preceding 2 months	10.4±1.9, 74 (drug) 8.5±2.2, 56 (placebo)	Drug: dry mouth, drowsiness, poor appetite, fatigue, headache, nausea, insomnia, dizziness; Placebo: dry mouth, loss of appetite, drowsiness, fatigue, dizziness, insomnia, nausea, headaches

Abbreviations: EKG, electrocardiography; FAP, functional abdominal pain; FD, funtional dyspepsia; GI, gastrointestinal; IBS, irritable bowel syndrome; RAP, recurrent abdominal pain; RCT, randomized, placebo-controlled trial.

CampoJVPerelJLucasACitalopram treatment of pediatric recurrent abdominal pain and comorbid internalizing disorders: an exploratory studyJ Am Acad Child Adolesc Psychiatry200443101234124215381890

 PubMed Web of Science ®Google Scholar

ChogleASapsMElectrocardiograms changes in children with functional gastrointestinal disorders on low dose amitriptylineWorld J Gastroenterol20142032113211132525170217

 PubMed Web of Science ®Google Scholar

JamesLPKearnsGLCyclic antidepressant toxicity in children and adolescentsJ Clin Pharmacol19953543433507650221

 PubMed Web of Science ®Google Scholar

SapsMBiringHSPusatciogluCKMintjensSRzeznikiewizDA comprehensive review of randomized placebo-controlled pharmacological clinical trials in children with functional abdominal pain disordersJ Pediatr Gastroenterol Nutr201560564565325906454

 PubMed Web of Science ®Google Scholar