Efficacy and safety of antidepressants for children and adolescents

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Abstract
Introduction Antidepressants introduced since 1990, especially selective serotonin reuptake inhibitors and venlafaxine, have been used increasingly as first line treatment for depression in children.1 2 The safety of prescribingantidepressants to children (including adolescents) has been the subject of increasing concern in the community and the medical profession, leading to recommendations against their use from government and industry (box 1). In this paper, we review the published literature on the efficacy and safety of newer antidepressants in children. References ↵ Chan RTW, Rey JM, Hazell PL . Clinical practice guidelines for depression in young people: are the treatment recommendations outdated? Med J Aust 2002; 177: 448–51. ↵ Safer DJ, Zito JM, dosReis S . Concomitant psychotropic medication for youths. Am J Psychiatry 2003; 160: 438. ↵ Keller MB, Ryan ND, Strober M, Klein RG, Kutcher SP, Birmaher B, et al . Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2001; 40: 762–72. ↵ Jureidini J, Tonkin A . Paroxetine in major depression (letter). J Am Acad Child Adolesc Psychiatry 2003; 42: 514. ↵ Simeon JG, Dinicola VF, Ferguson HB, Copping W . Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up. Prog Neuropsychopharmacol Biol Psychiatry 1990; 14: 791–5. ↵ Mandoki MW, Tapia MR, Tapia MA, Sumner GS, Parker JL . Venlafaxine in the treatment of children and adolescents with major depression. Psychopharmacol Bull 1997; 33: 149–54. ↵ Emslie GJ, Rush AJ, Weinberg WA, Kowatch RA, Hughes CW, Carmody T, et al . A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry 1997; 54: 1031–7. ↵ Emslie GJ, Heiligenstein JH, Wagner KD, Hoog SL, Ernest DE, Brown E, et al . Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2002; 41: 1205–15. ↵ Wagner KD, Ambrosini P, Rynn M, Wohlberg C, Yang R, Greenbaum MS, et al . Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder: two randomized controlled trials. JAMA 2003; 290: 1033–41. ↵ Braconnier A, Le Coent R, Cohen D . Paroxetine versus clomipramine in adolescents with severe major depression: a double-blind, randomized, multicenter trial. J Am Acad Child Adolesc Psychiatry 2003; 42: 22–9. ↵ FDA Center for Drug Evaluation and Research . Background on suicidality associated with antidepressant drug treatment (memorandum). www.fda.gov/ohrms/dockets/ac/04/briefing/4006B1_03_Background%20Memo%2001–05-04.htm (accessed 17 Feb 2004). ↵ King RA, Riddle MA, Chappell PB, Hardin MT, Anderson GM, Lombroso P, et al . Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment. J Am Acad Child Adolesc Psychiatry 1991; 30: 179–86. ↵ Herxheimer A, Mintzes B . Antidepressants and adverse effects in young patients: uncovering the evidence. CMAJ 2004; 170: 487–9. ↵ Kirsch I . St John's wort, conventional medication and placebo. Complement Ther Med 2003; 11: 193–5. ↵ Moncrieff J, Wessely S, Hardy R . Active placebo versus antidepressants for depression. Cochrane Database Syst Rev 2004;(1): CD003012 ↵ Hughes CW, Emslie G, Kowatch R, Weinberg W, Rintelman J, Rush J . Clinician, parent, and child prediction of medication or placebo in double-blind depression study. Neuropsychopharmacol 2000; 23: 591–4. ↵ Quitkin FM . Placebos, drug effects, and study design: a clinician's guide. Am J Psychiatry 1999; 156: 829–36. ↵ Swartzman LC, Burkell J . Expectations and the placebo effect in clinical drug trials: why we should not turn a blind eye to unblinding, and other cautionary notes. Clin Pharmacol Ther 1998; 64: 1–7. ↵ Varley CK . Psychopharmacological treatment of major depressive disorder in children and adolescents. JAMA 2003; 290: 1091–3. ↵ Keller MB, Ryan ND, Strober M, Weller EB, McCafferty JP, Hagino OR, et al . Paroxetine in major depression (letter). J Am Acad Child Adolesc Psychiatry 2003; 42: 515–6. ↵ FDA Center for Drug Evaluation and Research . Statistical review of Prozac for pediatric OCD and depression. www.fda.gov/cder/foi/nda/2003/18936S064_Prozac%20Pulvules_statr.pdf (accessed 17 Feb 2004). ↵ Committee on Safety of Medicines . Selective serotonin reuptake inhibitors (SSRIs)—overview of regulatory status and CSM advice relating to major depressive disorder (MDD) in children and adolescents: summary of clinical trials. medicines.mhra.gov.uk/ourwork/monitorsafequalmed/safetymessages/ssrioverviewclintrialdata_101203.htm (accessed 18 Feb 2004). ↵ Harrington R, Whittaker J, Shoebridge P, Campbell F . Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. BMJ 1998; 316: 1559–63. ↵ Lasser KE, Allen PD, Woolhandler SJ, Himmelstein DU, Wolfe SM, Bor DH . Timing of new black box warnings and withdrawals for prescription medications. JAMA 2002; 287: 2215–20.