A meta-analysis of antidepressant outcome studies that involved children and adolescents

Thurber, Steve; Ensign, John; Punnett, Audrey F.; Welter, Kelly

doi:10.1002/1097-4679(199505)51:3<340::aid-jclp2270510304>3.0.co;2-s

Cited by 12 publications

(4 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some site psychiatrists expressed the concern that quiet, depressed children were not being prescribed potentially beneficial medications because such children were less likely to come to the attention of a physician than those with behavior disorders. Alternative explanations may be that clinicians were responding to the lack of evidence regarding the efficacy of antidepressants in adolescents (Ambrosini, Bianchi, Rabinovich, & Elia, 1993a;Ambrosini et al, 1993b;Ryan, 1993;Thurber, Ensign, Punnett, & Welter, 1995) or that nonpharmacological interventions may have been tried more readily and satisfactorily for children with depression.…”

Section: Discussionmentioning

confidence: 99%

An Examination of Psychotropic Drug Treatment for Children with Serious Emotional Disturbance

Hallfors

Fallon

Watson

1998

Journal of Emotional and Behavioral Disorders

View full text Add to dashboard Cite

Psychotropic medication is an important factor in the care of children with serious emotional disturbance (SED) in community settings. In this article, we describe the use of medication in two sites that participated in the Robert Wood Johnson Foundation's Mental Health Services Program for Youth (MHSPY). Partaicipants included a total of 488 children and youth, enrolled at either the Cleveland, Ohio, or state of Vermont site. Forty percent of the study population received psychotropic medication during their enrollment in the program. Characteristics associated with use were analyzed using logistic regression. Although adolescent boys with conduct disorders appeared to be targeted by the MHSPY, younger children, girls, and those with attention-deficit/hyperactivity disorder (ADHD) or psychotic disorder diagnoses were more likely to receive medication. Stimulants, tricyclic antidepressants, and neuroleptics were the drug types most frequently prescribed. Rates of medication use in the MHSPY program were high but not unexpected, given the targeting of children with significant histories of emotional and behavioral challenges and imminent risk of restrictive placement. As new policies increasingly shift to community-based care for children with SED and to delivering such care through Medicaid managed care plans, careful evaluation of the risks and benefits of medication treatment is essential.

show abstract

Section: Discussionmentioning

confidence: 99%

An Examination of Psychotropic Drug Treatment for Children with Serious Emotional Disturbance

Hallfors

Fallon

Watson

1998

Journal of Emotional and Behavioral Disorders

View full text Add to dashboard Cite

show abstract

“…Also, the effect size was reported from five studies with dichotomous outcome (improved/not improved) as an odds ratio of 1.08 (95% CI = 0.53-2.17) indicating a similar likelihood of response for the pooled TCA-treated (38.5%) and placebo-treated (37.1%) youths. During the same year, there was a review of 27 outcome studies involving antidepressant treatment (although not restricted to the more rigorous randomized, double-blind, controlled parallel group clinical trial design) [20]. The authors found the studies substantially lacking in each of the criteria for the review, namely 1) the degree of blindedness, 2) placebo-controlled designs, 3) rating scale issues, 4) sample size, 5) inclusion criteria, and 6) other methodologic issues.…”

Section: Randomized Clinical Trials and Gaps In The Evidence Basementioning

confidence: 99%

Antidepressant treatment in children and adolescents: Bridging the gap between efficacy and effectiveness

Zito

Safer

2001

Curr Psychiatry Rep

View full text Add to dashboard Cite

This review of antidepressant treatments in children and adolescents emphasizes the gap between efficacy data derived from randomized clinical trials (RCTs) and the limited effectiveness data from community-based practices. Part one is a brief review of data from randomized, double-blind clinical trials to assess the evidence base for the major approved indications for antidepressants in youths. Part two reviews information gaps in the evidence from RCTs. Part three discusses nonexperimental evidence of the use of antidepressants, including surveys of prescription sales, physician surveys, and population-based data. Part four presents a comprehensive model for assessing the use of antidepressants in youths in the community. The model aims to answer a range of public health-oriented questions and is intended to improve treating physicians' and clinical care providers' ability to manage medications for optimal patient benefit. Suggestions are made for engaging health service providers, health insurers, academicians, advocates, and the government in building the necessary infrastructure to make effectiveness as vital as efficacy to the model of drug therapy evaluation.

show abstract

“…The small number of controlled systematic pharmacotherapy trials completed to date in general have failed to demonstrate the efficacy of tricyclic or serotonergic antidepressants for the acute treatment of child or adolescent major depression (Table 1). Two double-blind placebo-controlled studies in children (Puig-Antich et al, 1987;Geller et al, 1989) and five double-blind studies in adolescents (Kramer and Feiguine, 1981;Geller et al, 1990;Klein et al, 1992;Kutcher et al, 1994;Kye et al, 1996) with tricyclic antidepressants (amitriptyline, nortriptyline, imipramine, and desipramine) have not reported significant differences between placebo and TCAs (Thurber et al, 1995;Birmaher et al, 1996b). One double-blind controlled study in children reported a statistically significant but clinically small antidepressant effect with imipramine (Preskorn et al, 1987).…”

Section: Pharmacotherapy Of Child and Adolescent Mddmentioning

confidence: 99%

Refractory depression in children and adolescents

Botteron

Geller

1997

Depress. Anxiety

View full text Add to dashboard Cite

Refractory or treatments resistant depression in child and adolescent populations is a difficult construct to operationalize currently. To date, only one of the small number of completed double‐blind placebo‐controlled treatment investigations have not demonstrated a significant effect of antidepressants in comparison to placebo. However, it has been established that child and adolescent MDD is a serious disorder that appears to have clinical continuity with adult affective disorders and is generally of long duration with high rates of recurrence and eventual progression to mania, substance abuse, or other serious psychopathology. In addition, families of children with affective disorders evidence substantial genetic loading with high rates of affective disorders contributing both genetic vulnerability and potential environmental risk as well. There have been no empirically identified treatments that alter the long‐term course of the illness. Thus treatment resistance is a significant issue for this population. This review will focus on controlled treatment trials and will examine the potential relevance of psychosocial impairment, genetic‐familial risk, and neuromorphometric brain differences to treatment resistance in children and adolescents with major depression. Depression and Anxiety 5:212–223, 1997. © 1997 Wiley‐Liss, Inc.

show abstract

A meta-analysis of antidepressant outcome studies that involved children and adolescents

Cited by 12 publications

References 19 publications

An Examination of Psychotropic Drug Treatment for Children with Serious Emotional Disturbance

An Examination of Psychotropic Drug Treatment for Children with Serious Emotional Disturbance

Antidepressant treatment in children and adolescents: Bridging the gap between efficacy and effectiveness

Refractory depression in children and adolescents

Contact Info

Product

Resources

About