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04 Jul 2016

Most antidepressants don’t work in the treatment of depression in children and adolescents, and could even be dangerous, a new study has shown.

The study, published in The Lancet, looked at the treatment of Major Depressive Disorder, one of the most common mental disorders in children and adolescents.

It reviewed studies of 14 of the most commonly prescribed antidepressants and found only one, fluoxetine, was more effective than a placebo at relieving depression in children and teenagers.

Lead study author, Dr Andrea Cipriani, of Oxford University, told The Lancet podcast that about 3 per cent of primary school aged children have the condition, and 6 per cent of high school aged adolescents.

“Another important thing to bear in mind is that Major Depressive Disorder in children and adolescents, compared with Major Depressive Disorder in adults, not only is it still underdiagnosed and under-treated, but also it tends to present in a different way,” he said.

“Depressive symptoms in children and adolescents are rather undifferentiated. You notice more irritability, aggressive behaviour, problems at school, and the consequences of depressive episodes in children and adolescents are dramatic because they include impairment in their social functioning but also an increased risk of suicidal ideation and attempts.”

The study was a systematic review and meta-analysis of the existing literature, which identified 34 randomised controlled trials involving 5260 participants with a mean age of between nine and 18 years, and 14 antidepressant treatments.

Researchers focused on two primary outcomes of antidepressant treatments – efficacy, (or change in depressive symptoms), and tolerability (whether treatment was discontinued due to adverse events).

They found that only fluoxetine was more effective than the placebo, and also rated better in terms of tolerability.

Patients given three drugs in particular - imipramine, venlafaxine and duloxetine - had more discontinuations due to adverse events than those given the placebo. Compared with placebos and five other antidepressant medications, venlafaxine was found to increase the risk of suicidal thoughts and attempts.

Dr Cipriani said the study’s results back up existing international guidelines which say that the starting point for childhood or adolescent depression should be psychological treatment, rather than antidepressants.

“International guidelines suggest to start with non-pharmacological interventions – psychological intervention - for children and adolescents with major depression,” he said.

“The reason being twofold – one is because of the evidence. We have some evidence that some of the psychological interventions like cognitive behavioural therapy, interpersonal therapy may work for these patients, and at the same time the recent meta data analysis showed that these are two interventions that might work.

“But, also, with children and adolescents, we are talking about a developing brain. We are always very cautious when prescribing medications because we don’t really know the potential implications long-term for the developing brain.”

Dr Cipriani said the next step for researchers would be to carry out a natural meta-analysis comparing pharmacological versus non pharmacological treatment, in order to have a proper ranking of treatments for young people with depression.

“However if we look at the evidence now, psychological treatment should be the front line treatment,” he said.

Debra Vermeer

Published: 04 Jul 2016