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Evidence summaries

Newer Generation Antidepressants in Childhood and Adolescent Depression

Depressed children and adolescents treated with an antidepressant appear to have lower depression severity scores than those on placebo, but the size of this difference is small, and there appears to be an increased risk (64%) of suicide-related outcomes for those on antidepressants. Level of evidence: "B"

A Cochrane review 2 (abstract , review [Abstract]) included 19 studies on the effectiveness of newer generation antidepressants for depressive disorders in children and adolescents, with a total of 3335 subjects.There was evidence that those treated with an antidepressant had lower depression severity scores and higher rates of response/remission than those on placebo. However, the size of these effects was small with a reduction in depression symptoms of 3.51 on a scale from 17 to 113 (14 trials; N = 2490; MD -3.51; 95% CI -4.55 to -2.47). Remission rates increased from 380 per 1000 to 448 per 1000 for those treated with an antidepressant. There was evidence of an increased risk (58%) of suicide-related outcome for those on antidepressants compared with a placebo (17 trials; N = 3229; RR 1.58; 95% CI 1.02 to 2.45). This equates to an increased risk in a group with a median baseline risk from 25 in 1000 to 40 in 1000.

Comment: The quality of evidence is downgraded by indirectness (differences between trials in the definition of response, clinical significance of the effect size unclear).

    References

    • Hetrick SE, McKenzie JE, Cox GR et al. Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database Syst Rev 2012;11():CD004851. [PubMed]

Primary/Secondary Keywords