The British Journal of Psychiatry (2008) 193: 10-17. doi: 10.1192/bjp.bp.106.031088
© 2008 The Royal College of Psychiatrists
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REVIEW ARTICLE

Efficacy of antidepressants in juvenile depression: meta-analysis

Evangelia M. Tsapakis*, BSc, MBBS, MSc, MRCPsych

Section of Clinical Neuropharmacology and MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK, and Department of Psychiatry, Harvard Medical School and Psychopharmacology Program, McLean Division of Massachusetts General Hospital, Boston, Massachusetts, USA

Federico Soldani*, MD, SM, PhD

Department of Epidemiology, Harvard School of Public Health, and Department of Psychiatry, Harvard Medical School and Psychopharmacology Program, McLean Division of Massachusetts General Hospital, Boston, Massachusetts, USA

Leonardo Tondo, MD, SM

Lucio Bini Mood Disorder Centre and Department of Psychology, University of Cagliari, Sardinia, Italy, and Department of Psychiatry, Harvard Medical School and Psychopharmacology Program, McLean Division of Massachusetts General Hospital, Boston, Massachusetts, USA

Ross J. Baldessarini, MD

Department of Psychiatry, Harvard Medical School, Psychopharmacology Program and International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence: Dr Evangelia M. Tsapakis, MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, PO Box 80, De Crespigny Park, London SE5 8AF, UK. Email: e.tsapakis{at}iop.kcl.ac.uk

Declaration of interest

E.M.T. has received research support from Johnson & Johnson Psychiatry Research and Development. L.T. has received research support or served as a consultant to JDS, IFI, Eli Lilly and Janssen Pharmaceutical Corporations. R.J.B. is a consultant to or has received research support from Janssen, IFI, JDS, Eli Lilly, Novartis and Solvay Pharmaceutical Corporations. Funding is detailed in the Acknowledgements.

*These authors contributed equally to the work.

Background

The safety of antidepressants in children and adolescents is being questioned and the efficacy of these drugs in juvenile depression remains uncertain.

Aims

To assess antidepressant efficacy in juvenile depression.

Method

Systematic review and meta-analysis of randomised controlled trials (RCTs) comparing responses to antidepressants, overall and by type, v. placebo in young people with depression.

Results

Thirty drug–placebo contrasts in RCTs lasting 8 weeks (median) involved 3069 participants (512 person-years) of average age 13.5 years. Meta-analysis yielded a modest pooled drug/placebo response rate ratio (RR=1.22, 95% CI 1.15–1.31), with little separation between antidepressant types. Findings were similar for response rate differences and corresponding number needed to treat (NNT): overall NNT=9; tricyclic antidepressants NNT=14 > serotonin reuptake inhibitors NNT=9 > other antidepressants NNT=8. Numbers needed to treat decreased with increasing age: children (NNT=21) > mixed ages (NNT=10) > adolescents (NNT=8).

Conclusions

Antidepressants of all types showed limited efficacy in juvenile depression, but fluoxetine might be more effective, especially in adolescents. Studies in children and in severely depressed, hospitalised or suicidal juvenile patients are needed, and effective, safe and readily accessible treatments for juvenile depression are urgently required.




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Antidepressants in depressed adolescents: to prescribe or not to prescribe?
Krishna Menon
BJP Online, 21 Aug 2008 [Full text]
Re: Antidepressants in depressed adolescents: to prescribe or not to prescribe?
Evangelia M Tsapakis, et al.
BJP Online, 19 Oct 2008 [Full text]