A comparative study on the use of antidepressants in children and adolescents (aged 9–18 years) found that these drugs offer no clear advantage for this population when considering the risk-benefit profile. 

The researchers carried out a meta-analysis of 34 randomized control trials identified from a range of medical journal databases. Antidepressant treatments evaluated in the study included: amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine. 

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Efficacy results showed that only fluoxetine performed better than placebo (SMD –0.51, 95% CrI –0.99 to –0.03). When ranked using the cumulative probability plots and surface under the cumulative ranking curve (SUCRA), fluoxetine scored highest for efficacy (76.6%), while nortriptyline was least effective (3.7%). Nortriptyline was shown to be considerably less effective than 7 other antidepressants and placebo (SMDs ranging between –1.65 and –1.14).

Fluoxetine also showed significantly greater tolerability than duloxetine (OR 0.31, 95% CrL 0.13 to 0.95) and imipramine (0.23, 0.4 to 0.78). Treatments tolerated worse than placebo were imipramine (5.49, 1.96 to 20.86), venlafaxine (3.19, 1.01 to 18.70) and duloxetine (2.80, 1.20 to 9.42).  Compared with placebo and five other antidepressants, venlafaxine was also associated with an increased risk of engaging in suicidal thoughts or attempts.

The authors note that their findings are limited due to the small number of trials in each node; for most treatments there were two trials comparing to placebo; fluoxetine had the most trials vs. placebo, with seven in total. “Moreover, poor methodology, risk of bias within individual studies, and potential selective reporting are important factors to be considered when interpreting the results from this meta-analysis,” write the authors.

Taking into account those caveats, the authors state that their findings demonstrate fluoxetine is the best option among antidepressants when pharmacological treatment is decided upon. They conclude, “Antidepressants are not well studied in this population, and further research on moderators of treatment effect and possible new interventions are needed.”

For more information visit TheLancet.com.