Children and adolescents with major depression do not benefit from most antidepressant medications, and some of these drugs may do more harm than good. This is the conclusion of a new study published in The Lancet.
Depression is a common mental disorder. Globally, an estimated 350 million people of all ages suffer from depression. Major depression, or major depressive disorder, is estimated to affect around 2.8% of children aged 6-12 years and 5.6% of adolescents aged 12-18 years in the United States, said the authors.
The condition is normally diagnosed if a child or adolescent experiences depressive symptoms including mood swings, irritability, frequent sadness, low self-esteem and thoughts of death or suicide for more than 2 weeks, medicalnewstoday.com reported.
For children and adolescents with major depression, most clinical guidelines recommend cognitive behavioral therapy (CBT) and other psychological therapies as the first-line treatment.
However, lead study author Dr. Andrea Cipriani, of the University of Oxford in the United Kingdom, and colleagues note that an increasing number of youngsters with major depression are being prescribed antidepressants.
They point to a study published earlier this year that found between 2005-2012, the proportion of children and adolescents (aged 0-19 years) in the US that were taking antidepressants rose from 1.3% to 1.6%.
Such an increase has occurred despite the Food and Drug Administration warning against antidepressant use for children and adolescents in 2004, after studies found increased suicide risk among young users of the drugs.
“Consequently, the question of whether to use antidepressant drugs for the treatment of major depressive disorder in young people and, if so, which antidepressant would be preferred, remains controversial,” say the authors, who investigated whether the benefits of antidepressant use outweigh the risks for young people with major depression.
Effectiveness
The trials included in the analysis assessed the effects of 14 antidepressant medications, and the team ranked the effectiveness of each medication using four criteria: efficacy, tolerability, acceptability and associated serious harms - whether the medication increased suicidal thoughts or events, or other harms.
In 34 of the trials - including 5,260 participants of average age 9-18 years - researchers identified only one antidepressant, fluoxetine, for which the benefits outweighed the risks when it came to efficacy and tolerability.
Compared with placebos and seven other antidepressants, nortriptyline was found to have lower efficacy.
The antidepressants imipramine, venlafaxine, and duloxetine fared worst when it came to tolerability, and venlafaxine was found to increase the risk of suicidal thoughts and attempts.
These results, the authors said, suggest that the vast majority of antidepressants are ineffective for children and adolescents with major depression, and many of them may be unsafe.
