title: Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability.
abstract: New generation antidepressant therapies, including serotonin-norepinephrine reuptake inhibitor (SNRIs), were introduced in the late 1980s; however, few comprehensive studies have compared the benefits and risks of various contemporary treatments for major depressive disorder (MDD) in young patients. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science, and PsycINFO databases was conducted from 1970 to January 2015. Only clinical trials that randomly assigned one SNRI or placebo to patients aged 7 to 18 years who met the diagnostic criteria for major depressive disorder were included. Treatment success, dropout rate, and suicidal ideation/attempt outcomes were measured. Primary efficacy was determined by pooling the risk ratios (RRs) of treatment response and remission. Acceptability was determined by pooling the RRs of dropouts for all reasons and for adverse effects as well as suicide-risk outcomes. Five trials with a total of 973 patients were included. SNRIs were not significantly more effective than placebo for treatment response but were for remission. The comparison of patients taking SNRIs that dropped out for all reasons and those taking placebo did not reach statistical significance. Significantly more patients taking SNRIs dropped out for adverse effects than those taking placebo. No significant difference was found in suicide-related risk outcomes. SNRI therapy does not display a superior efficacy and is not better tolerated compared to placebo in these young patients. However, duloxetine has a potential beneficial effect for depression in young populations, showing a need for further research.
authors.affiliation: Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.|Chongqing Key Laboratory of Neurobiology, Chongqing, China.|Institute of Neuroscience, Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.|Chongqing Key Laboratory of Neurobiology, Chongqing, China.|Institute of Neuroscience, Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China.
authors.forename: S J
authors.initials: SJ
authors.lastname: Bai
authors.affiliation: Chongqing Key Laboratory of Neurobiology, Chongqing, China.|Institute of Neuroscience, Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China.
authors.forename: X H
authors.initials: XH
authors.lastname: Lan
authors.affiliation: Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.|Chongqing Key Laboratory of Neurobiology, Chongqing, China.|Institute of Neuroscience, Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China.
authors.forename: B
authors.initials: B
authors.lastname: Qin
authors.affiliation: Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.|Chongqing Key Laboratory of Neurobiology, Chongqing, China.|Institute of Neuroscience, Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China.
authors.forename: T
authors.initials: T
authors.lastname: Huang
authors.affiliation: Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.|Chongqing Key Laboratory of Neurobiology, Chongqing, China.|Institute of Neuroscience, Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China.
authors.forename: P
authors.initials: P
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D003521:Cyclopropanes / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy*; D000069468:Desvenlafaxine Succinate / Q000627:therapeutic use; D000068736:Duloxetine Hydrochloride / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D000078764:Milnacipran; D010919:Placebos / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D003521:Cyclopropanes; D010919:Placebos; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride; D000068736:Duloxetine Hydrochloride; D000078764:Milnacipran; D000069468:Desvenlafaxine Succinate