Efficacy and safety of antidepressants for children and adolescents

Abstract

How safe and effective are antidepressants in children and adolescents? The authors of this review have found disturbing shortcomings in the methods and reporting of trials of newer antidepressants in this patient group Antidepressants introduced since 1990, especially selective serotonin reuptake inhibitors and venlafaxine, have been used increasingly as first line treatment for depression in children. 1 2 The safety of prescribing antidepressants to children (including adolescents) has been the subject of increasing concern in the community and the medical profession, leading to recommendations against their use from government and industry (box 1). In this paper, we review the published literature on the efficacy and safety of newer antidepressants in children. MethodsHaving criticised the way in which Keller et al interpreted the results of their study, 3 4 we sought to check the quality of methods and reporting of other published trials of newer antidepressants in children (box 2). Of seven published randomised controlled trials of newer antidepressants for depressed children published in refereed journals, six used a placebo control. 3 5-9 We analysed each study's methods and the extent to which authors' conclusions were supported by data. The seventh study, which compared a newer antidepressant with a tricyclic antidepressant without finding significant difference, 10 was not included in the analysis but appears in the table on bmj.com.

fMRI predictors of treatment outcome in pediatric anxiety disorders

“…Identification of such a biological marker of treatment response among pediatric patients would advance the field dramatically. As recent reviews have concluded, randomized controlled trials indicate that current treatments are effective for only a subset of youth with anxiety and mood disorders (40,41). Although symptom severity and the presence of comorbid disorders sometimes predict poorer outcomes (23), this is not always the case.…”

Selective Serotonin Reuptake Inhibitor and Venlafaxine Use in Children and Adolescents with Major Depressive Disorder: A Systematic Review of Published Randomized Controlled Trials

“…This review critiques the evidence of efficacy and safety available from published RCTs of SSRI or venlafaxine use in children and adolescents. It is important to note that, after this article was submitted for publication, Jureidini and others published a review with a nearly identical purpose (12). Their paper examines the identical list of articles but emphasizes different critiques of the research, some of which overlap with the discussion below.…”

The psychology of neurofeedback: Clinical intervention even if applied placebo.

“…For example, consider the field of child psychiatry (Raz, 2006). On the one hand, pediatric antidepressant treatment carries an NNT between 3 and 10 (i.e., for every three to ten children administered antidepressants, only one will improve better than placebo), an NNH (e.g., in terms of suicidal ideation or suicide attempt) from 112 to 200 (Bridge et al, 2007), and a range of potentially severe side-effects (Jureidini, Doecke, Mansfield, Haby, & Menkes, 2004); pharmacological treatment of ADHD with atomoxetine carries an NNT of 3 for treatment response and 10 for relapse prevention, and an NNH of 9 for abdominal pain, 22 for vomiting, 30 for dyspepsia, and 19 for somnolence (Cheng, Chen, Ko, & Ng, 2007). On the other hand, EEGnf studies rarely report NNT or NNH, yet side-effects remain mild and uncommon (Hammond & Kirk, 2008), and positive outcomes appear to persist well beyond the treatment period (Gani, Birbaumer, & Strehl, 2008;Gevensleben et al, 2010;Leins et al, 2007;Strehl, Leins, et al, 2006).…”