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

Abstract

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.

Rising Prevalence of Antidepressants Among US Youths

“…First, the evidence base for SSRI use to treat depression among youths who are younger than 15 years is meager, [2][3][4]30,31 and must be strengthened in view of prominent utilization (41% were prescribed an SSRI in 1994 in association with the diagnosis of depression). Second, research shows that a substantial proportion of SSRI use occurs in combination with stimulants, 32 a combination for which there are no effectiveness or safety data.…”

“…1 For adults, ATDs are indicated for the treatment of a wide variety of emotional disorders, 1 whereas for youths there are few evidenced-based indications for their use. [2][3][4] Nonetheless, survey data from 1985 to 1993/1994 indicate that increases in ATD treatment have been far greater proportionally for youths than for adults. 5 Although the prominent increase in fluoxetine prescriptions for youths in the United States has been featured in the lay press, 6 -8 little is known about community ATD treatment patterns of youths.…”