Most antidepressants not working for children or teens
Treating children and teenagers suffering from depression with antidepressants may be both ineffective and potentially dangerous, experts warn.
A review of clinical trial evidence found that out of 14 antidepressant drugs, only one, fluoxetine, known as Prozac, was better than a placebo at relieving the symptoms of young people with major depression. Another drug, Effexor (venlafaxine) was linked to a higher risk of suicidal thoughts and attempts, compared to a placebo and five other antidepressants, researchers reported.
Study author Dr Andrea Cipriani, from the University of Oxford, England, and his colleagues reviewed 34 studies that included more than 5,200 children and teens. Such a study tries to find common ground between numerous trials, and the findings can be limited as the conclusions rely on how well the studies were conducted. However, the researchers stressed that the effectiveness and safety of antidepressants taken by children and teenagers remains unclear because of the design and reporting of trials, which were mostly funded by drug companies.
Accordingly, the researchers recommended close monitoring of young people on antidepressants, regardless of what drugs they were prescribed, especially at the start of treatment.
"In the clinical care of young people with major depressive disorder, clinical guidelines recommend psychotherapy - especially cognitive behavioural therapy or interpersonal therapy - as the first-line treatment," said Dr Cipriani. "Prozac should be considered only for patients who do not have access to psychotherapy or have not responded to non-pharmacological interventions."
And because the available studies of antidepressant use among children and adolescents are limited and of questionable quality, "we should not underestimate these potential risks".
"Children and adolescents taking antidepressant drugs should be closely monitored regardless of the treatment chosen," Dr Cipriani advised.
Major depression affects about 3 per cent of children aged six to 12, and 6 per cent of teens aged 13 to 18, the researchers noted.
In 2004 the U.S. Food and Drug Administration (FDA) issued a warning against the use of antidepressants in young people up to the age of 24 because of concerns about suicide risk.
Yet the number of young people taking the drugs increased between 2005 and 2012, both in the U.S. and U.K., said the study authors.
The review was published in journal The Lancet.