Is There Evidence for Antidepressant Medications in Children and Adolescents?
When a young individual presents with serious symptoms of depression, parents have difficult decisions to make about how to address the condition. A recent meta-analysis in the Lancet (statistical analysis of many different studies) aimed to shed light on the evidence base for the prescription of antidepressant medication (such as selective serotonin reuptake inhibitors like Prozac).
They found that Prozac outperformed placebo with a medium effect size (suggesting there is evidence for its use, and that the statistics suggest a moderate ability to reduce symptoms) in treating depression in children and adolescents. Also importantly, a statistically significant (proven to not be random chance) increased risk of suicidal ideation was noted with venlafaxine, which would suggest avoiding it in this group of patients.
Although this analysis provides good information, the authors recognize that the studies they considered in some cases were flawed, and that the patients studied were not a wide variety (mainly major depression). Additionally, that they could not guarantee the accuracy of the studies they looked at because they did not have access to the original patient information researchers collected.
This study emphasizes that given the limits of evidence we have for prescription medication for depression in children and adolescents, psychotherapy and other non-medication interventions should be tried first before starting a trial of a medication. It appears that fluoxetine is a good starting point if medication is indicated based on the evidence we have today and that venlafaxine should be avoided in the young. Other medication has less evidence for use, but in some cases it is necessary to attempt trials for serious and debilitating symptoms that don’t respond to psychotherapy or fluoxetine. Parents should look for any changes in suicidal thoughts in their children on SSRI medication, particularly early in the treatment. It is important to note that newer medications for depression were not included in the study.
© Neevon Esmaili 2016
Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis
Author: Andrea Cipriani, Xinyu Zhou, Cinzia Del Giovane, Sarah E Hetrick, Bin Qin, Craig Whittington, David Coghill, Yuqing Zhang, Philip Hazell, Stefan Leucht, Pim Cuijpers, Juncai Pu,David Cohen, Arun V Ravindran, Yiyun Liu, Kurt D Michael, Lining Yang, Lanxiang Liu et al.
Publication: The Lancet
Available online 8 June 2016
Neevon Esmaili, MD
Child Adolescent, & Adult Psychiatrist
Dual Board Certified
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