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antidepresant pillsJune 15 2016

The bulk of commonly used antidepressants appear to have little value in the acute treatment of major depressive disorder in children or adolescents.

Researchers conducting a meta-analysis of 34 trials involving 5,260 patients looking at 14 antidepressants have concluded that the majority do not seem to offer a clear advantage. However, “fluoxetene is probably the best option to consider when a pharmacological treatment is indicated,” said the paper published in the Lancet.

Trials included in the analysis were studies on amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine.

Patients had been using the medicine for at least four weeks. Outcomes were efficacy which was measured by a change in depressive symptoms, and tolerability which was rated by discontinuations due to adverse events.

Overall, the quality of the evidence was rated very low for most of the trials. In terms of efficacy, “only fluoxetine was statistically significantly more effective than placebo (standardised mean difference −0·51, 95% credible interval −0·99 to −0·03)”. Fluoxetene was also better than duloxetine and imipramine in terms of tolerability.

Imipramine, venlafaxine, and duloxetine were associated with more discontinuations due to adverse effects than compared to placebo.

“When considering the risk–benefit profile of antidepressants in the acute treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents,” concluded the researchers
The Royal College of Paediatrics and Child Health noted that about 900,000 children in Britain are thought to be on prescribed antidepressants. NHS guidelines recommend fluoxetene for teenagers with severe depression, though the drug and other SSRIs have been linked to serious side-effects in under-18s but not adults.

Young Minds, the charity committed to improving the emotional wellbeing and mental health of children and young people, has warned that there can be a decade between a child displaying their first symptoms of a mental health problem and actually getting help. It has flagged up a study conducted by the Centre for Mental Health which said that opportunities to offer effective support early on are often being missed.

YoungMinds Chief Executive Sarah Brennan said: “Many of the parents who call our helpline are furious that their children have to reach a state of crisis before they receive support. They say that a lack of timely treatment can cause their children to self-harm or become suicidal, to be violent and aggressive, or to drop out of school, ruining their prospects for the future. Parents are being forced to leave their jobs to look after their children and are desperately searching for support and not knowing where to turn.

“We know that early intervention is crucial when dealing with mental health problems. But many local authorities have repeatedly had their budgets slashed on things like social workers, support programmes for parents, educational psychologists and targeted mental health services in schools. This has put a huge burden on services further up the chain, which simply can’t cope with the demand. Draining money from early intervention is incredibly short-sighted, and just stores up problems for the future.”

Links:

A Cipriani et al. ‘Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis

RCPCH comment

Young Minds announcement

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