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Antidepressants offer minimal symptom improvement in children with major depressive disorder, while increasing the risk of side effects and treatment discontinuation.
A systematic review & meta-analysis of 22 randomized controlled trials found that antidepressants provide only slight symptom relief in pediatric depression while significantly escalating the risk of side effects. Higher doses led to more treatment dropouts due to side effects, with minimal improvement in response.
This dose-response study by Yuan Zhang et al. assessed the effects of antidepressants on treatment response, remission, suicidality, acceptability, and tolerability in children battling major depressive disorder (MDD). Researchers examined 22 trials, primarily spanning 6 to 12 weeks, using data from sources such as Ovid Embase, Wanfang, PubMed, and ClinicalTrial.gov. Conversion of antidepressant doses to fluoxetine equivalents was done. For assessing and adjusting for publication bias, the trim-and fill method, funnel plot, and sensitivity analysis were employed.
The findings showed that while antidepressants offered a slight advantage over placebos in treatment response, they were associated with a notably higher risk of adverse effects. There were no vital differences in remission rates, suicidality, or overall dropout rates. Dose-response trends indicated minimal improvement with escalating fluoxetine-equivalent doses, yet a pronounced escalation in discontinuation due to side effects.
Findings indicate that antidepressants may not work as effectively for pediatric MDD as they do for adults, highlighting the importance of weighing their limited benefits against the heightened risk of side effects in children.
European Child & Adolescent Psychiatry
Antidepressant treatment of depression in children and adolescents: a systematic review and dose-response meta-analysis
Yuan Zhang et al.
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