Are the SSRIs and atypical antidepressants safe and effective for children and adolescents?
OBJECTIVE
This article summarizes recent developments in the use of selective serotonin reuptake inhibitors and atypical antidepressants to treat children and adolescents with depression at a time when their use in this context has generated considerable controversy and confusion for clinicians, patients and their families. Recent reports and recommendations from drug regulators in the UK and the US are discussed, alongside other reviews and recently published randomized controlled trials.


RESULTS
It is now widely accepted that these drugs increase the risk of suicide-related behaviours and although recently published trials have been more positive, a meta-analysis of published and unpublished trials has cast doubt about efficacy. The evidence for publication bias in the studies considered is also raised and the implications discussed. There is some evidence, however, that the combination of psychological treatment with fluoxetine may be both effective and protective against the increased risk of suicide-related behaviours, although problems over blinding suggest further research is needed to clarify this potentially positive combination treatment.


CONCLUSIONS
Current evidence supports the conclusions of the UK drug regulator in warning against the use of all the newer antidepressants except fluoxetine in this age group, and alternative therapies should be sought in the first instance. Caution is needed in interpreting drug company sponsored trials given the evidence of selective reporting and publication bias. Combining fluoxetine with a psychological treatment such as cognitive-behavioural therapy is also worth considering.
Whittington
Craig J
CJ
CORE, Sub-department of Clinical Health Psychology, University College London, London, UK. c.whittington@ucl.ac.uk
Kendall
Tim
T
Pilling
Steve
S