Efficacy of antidepressants in juvenile depression: meta-analysis.
BACKGROUND
The safety of antidepressants in children and adolescents is being questioned and the efficacy of these drugs in juvenile depression remains uncertain.


OBJECTIVE
To assess antidepressant efficacy in juvenile depression.


METHODS
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.
Tsapakis
Evangelia M
EM
MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, De Crespigny Park, London, UK. e.tsapakis@iop.kcl.ac.uk
Soldani
Federico
F
Tondo
Leonardo
L
Baldessarini
Ross J
RJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors