The majority of antidepressants prescribed to treat children and teenagers with major depression are ineffective and may even be unsafe, warn researchers.
The finding comes from the most comprehensive analysis to date of all published and unpublished trials on 14 commonly prescribed antidepressants. Dr Andrea Cipriani (University of Oxford, UK) and colleagues looked at the effects of the drugs among young individuals with major depression up to the end of may 2015 and ranked the drugs by efficiency, tolerability, acceptability and associated harms such as suicidal thoughts and attempts.
The analysis, which included 34 trials and involved 5260 participants (aged 9 to 18 years), showed that only one of the drugs, fluoxetine, was found to be more effective at relieving depression than placebo. Nortriptyline was less effective than placebo and also seven other antidepressants.
The worst tolerability profile was found for imipramine, duloxetine and venlafaxine, which led to more discontinuations, compared with placebo. Venlafaxine was also found to be associated with an increased risk of suicidal thoughts and attempts.
The authors say the true effectiveness and risk of associated suicidality could not be accurately assessed for all the drugs due to the small number and poor design of the trials, the lack of individual patient-level data and the selective reporting of findings.
Pharmaceutical companies funded 65% of the trials and 29% were classed as having a high risk of bias, 20% a moderate risk and 12% a low risk.
In an associated commentary, Jon Juereidini (University of Adelaide) asks how many more cases of suicidal events may have been found if data had been available for patients on an individual level.
He raises, for example, the point that among four trials of paroxetine, such events were reported for only 13 of 413 (3%) people taking the drug, whereas a re-analysis of individual patient data for just one of those trials found ten such events among just 93 patients, which translates as 10.8%.
Jureidini says the effect of such misreporting is that antidepressants are likely to be less effective and more dangerous than was previously thought and leaves little reason to believe that taking antidepressants is any better for children and teens than not taking anything.
The balance of risks and benefits of antidepressants for the treatment of major depression does not seem to offer a clear advantage in children and teenagers, with probably only the exception of fluoxetine.”
“We recommend that children and adolescents taking antidepressants should be monitored closely, regardless of the antidepressant chosen, particularly at the beginning of treatment.”
Co-author of the paper, Peng Xie.