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July

Antidepressants have limited efficacy in juvenile depression

JULY 22, 2008

Dr Eva M Tsapakis, Section of Clinical Neuropharmacology and MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, and colleagues from Harvard Medical School, USA and University of Cagliari, Sardinia, has published a review and meta-analysis entitled 'Efficacy of antidepressants in juvenile depression: meta-analysis' in the July issue of the British Journal of Psychiatry.   

In an environment where the safety and efficacy of antidepressants for juvenile depression are being questioned, the authors carried out a systematic meta-analysis aimed at critically evaluating all types of antidepressants.  They also compared treatment responses in children versus adolescents and with serotonin reuptake inhibitors (SRIs) versus other types of anti-depressants. 

The authors looked at randomised controlled trials involving 3069 participants and found that antidepressants of all types showed limited clinical efficacy in juvenile depression.  Antidepressants are possibly less effective in children than adolescents and substantially less effective in juveniles than in adults.   A particular type of SRI, fluoxetine, was found to be potentially more effective especially in adolescents. 

These findings have important risk-benefit implications given current discussion around suicidal thinking and self-injurious behaviour in juveniles during treatment with an SRI.  The authors report that further studies in children and in severely depressed, hospitalised or suicidal juvenile patients are needed and effective safe and readily accessible treatment for juvenile depression are urgently required.     

The papers authors are:  Evangelia M Tsapakis, Federico Soldani, Leonardo Tondo and Ross J Baldessarini.  Dr Tsapakis was on a Royal College of Psychiatrists Travelling Fellowship at Harvard Medical School while undertaking this review.

For a full copy of the article please go to the British Journal of Psychiatry   http://bjp.rcpsych.org/content/193/1/10.abstract
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