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Most antidepressants have been found to be ineffective for children and teenagers, with some potentially doing more harm than good.
By
Kemal Atlay

9 Jun 2016 - 3:41 PM  UPDATED 9 Jun 2016 - 3:41 PM

Most antidepressants have been found to be ineffective in treating depression in children and teenagers and some may even do more harm than good, according to new study.

An international team of researchers, led by psychiatrist Dr Andrea Cipriani from the University of Oxford in the UK, conducted an extensive review and meta-analysis of 34 clinical trials of 14 different antidepressants and found that only fluoxetine, or Prozac, was more effective at relieving the symptoms of major depressive disorder than a placebo. 

The study was published today in The Lancet.

“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,” Dr Cipriani says.

Their findings also indicated that three antidepressants – imipramine, venlafaxine and duloxetine – had the worst profiles in terms of tolerability, and that venlafaxine was linked with an increased risk of suicidal thoughts and attempts.

Major depressive disorder is one of the most common mental health disorders for youth and affects around 3 per cent of children (aged 6 to 12 years) and 6 per cent of adolescents (aged 13 to 18 years).

The researchers recommended that children and teenagers should be closely monitored when taking antidepressants, particularly at the start of treatment, regardless of the type prescribed.

The researchers recommended that children and teenagers should be closely monitored when taking antidepressants, particularly at the start of treatment, regardless of the type prescribed.

However Dr Jon Jureidini, a child psychiatrist from the University of Adelaide, believes the recommendations did not go far enough in persuading the medical community away from prescribing antidepressants for depression in youth.

“It’s not surprising to me but it’s good to have it confirmed with a study with good methodology that antidepressants aren’t good drugs for kids,” Dr Jureidini tells SBS.

“I don’t think we should be considering pharmacological intervention, I think we should be saying we have to make other things work for kids.”

Dr Jureidini also says that diagnosing children with depression, as well as other mental health disorders like attention deficit hyperactivity disorder (ADHD) and anxiety, is often unhelpful.

“There’s no trouble identifying symptom patterns of any of those conditions in children, you can do that reliably, but… what you’ve got to try to understand is why are the kids responding in that way,” he says.

He argues that clinicians should be more focused on identifying and understanding the causes of distress in children and teenagers, as addressing those issues can often be of great benefit to their mental and emotional development.

I don’t think we should be considering pharmacological intervention, I think we should be saying we have to make other things work for kids.

The study researchers also noted that it was difficult to gauge the true effectiveness of these drugs, as well as their associated side effects such as suicidal behaviour, due to the small number and poor design of available clinical trials available and the lack of access to the raw data from the studies.

“The problem with the strength of these results is probably limited by the quality of the data… we know now that using only the summary data from the trials, we don’t have a clear picture of what is happening to our patients,” Dr Cipriani says.

“Access to raw clinical data [will] provide, I think, a unique opportunity for validation and replication of results. It allows more sophisticated statistical elaboration.”

This echoed growing calls within the scientific community for greater transparency by making individual patient-level data available for others to analyse, and would also prevent underreporting of adverse effects.

“A lot of adverse events don’t get properly reported,” Dr Jureidini says.

“People like Cipriani need to be given access to that data and what they would almost certainly find is that the adverse effect profiles of these drugs are much worse than they appear to be.”

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