Newer generation antidepressants in childhood and adolescent depression
Sübutlu məlumatların xülasələri
05.02.2018 • Sonuncu dəyişiklik 05.02.2018
Editors
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.
A systematic review and meta-analysis
included 6 published and 6 unpublished RCTs evaluating an SSRI versus placebo in participants aged 5–18 years. Fluoxetine (2 published trials, n=315) showed a benefit for remission and response, and the adverse event data were not statistically significant as compared to placebo (discontinuation 5.7% vs. 6.3%, weighted RRI 19%, 95% CI –82 to 685, 2 trials; suicide attempt 2.4% vs. 1.9%; weighted RRI 26%, 95% CI –64 to 340, 2 trials; serious adverse events 0.9% vs. 3.6%, RRR 75%, 95% CI –122 to 97, 1 trial). Unpublished data lended support to the findings. Published results from one trial of paroxetine and two trials of sertraline suggest equivocal or weak positive risk-benefit profiles. Paroxetine increased remission but not response and increased serious adverse events, and sertraline did not show a benefit for remission and led to more dropouts because of adverse events. In both cases, addition of unpublished data indicated that risks outweigh benefits. Data from unpublished trials of citalopram
and venlafaxine show unfavourable risk-benefit profiles. Citalopram led to a small reduction in depressive symptoms, and venlafaxine had no effect; adverse events were increased for both drugs.
"?>
A Cochrane review (abstract , review ) 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).
Ədəbiyyat
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Whittington CJ, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Boddington E. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 2004 Apr 24;363(9418):1341-5.
- 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.