title: Efficacy and tolerability of antidepressants in the treatment of adolescents and young adults with depression and substance use disorders: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To measure the effectiveness of antidepressants for adolescents and young adults with co-occurring depression and substance use disorder.
  
  
  METHODS
  Meta-analysis of randomized controlled clinical trials. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science and PsychINFO was conducted (from 1970 to 2013). Prospective, parallel groups, double-blind, controlled trials with random assignment to an antidepressant or placebo on young patients (age ≤ 25 years) who met diagnostic criteria of both substance use and unipolar depressive disorder were included. Five trials were selected for this analysis and included 290 patients.
  
  
  METHODS
  Our efficacy outcome measures were depression outcomes (dichotomous and continuous measures) and substance-use outcomes (change of frequency or quantity of substance-use). Secondary analysis was conducted to access the tolerability of antidepressant treatment.
  
  
  RESULTS
  For dichotomous depression outcome, antidepressants group was significantly more effective than placebo group [risk ratio (RR) = 1.21; 95% confidence interval (CI) 1.01-1.45], with low heterogeneity (I(2)  = 0%). Although no statistically significant effects for continuous depression outcome [standardized mean differences (SMD) = -0.13; 95% CI, -0.55 to 0.30] were found with moderate heterogeneity (I(2)  = 63%), subgroup analysis showed that the medicine group with a sample size of more than 50 showed statistically significant efficacy compared with the placebo group (SMD -0.53, 95% CI -0.82 to -0.25). Moreover, there was no significant difference for substance-use outcomes and tolerability outcomes between the medication and placebo groups.
  
  
  CONCLUSIONS
  Antidepressant medication has a small overall effect in reducing depression in young patients with combined depressive and substance-use disorders, but does not appear to improve substance use outcomes.
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Zhou
authors.forename: Bin
authors.initials: B
authors.lastname: Qin
authors.forename: Cinzia
authors.initials: C
authors.lastname: Del Giovane
authors.forename: Junxi
authors.initials: J
authors.lastname: Pan
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gentile
authors.forename: Yiyun
authors.initials: Y
authors.lastname: Liu
authors.forename: Xinghui
authors.initials: X
authors.lastname: Lan
authors.forename: Jia
authors.initials: J
authors.lastname: Yu
authors.forename: Peng
authors.initials: P
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D017594:Publication Bias; D011785:Quality Assurance, Health Care; D019966:Substance-Related Disorders / Q000150:complications / Q000188:drug therapy*; D013405:Suicide / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: adolescents; antidepressants; major depressive disorder; meta-analysis; substance use disorders; systematic review