Efficacy of antidepressants in juvenile depression: meta-analysis

Tsapakis, Eva-Maria; Soldani, Federico; Tondo, Leonardo; Baldessarini, Ross J.

doi:10.1192/bjp.bp.106.031088

Cited by 131 publications

(88 citation statements)

References 60 publications

(113 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present findings are congruent with reviews discussed above indicating that antidepressant drug-vs-placebo differences in published reports of controlled trials are generally moderate (Baldessarini, 2005;Gartlehner et al, 2008;Kirsch et al, 2008;Tsapakis et al, 2008;Bridge et al, 2009;Wooley et al, 2009;Masi et al, 2010;Pigott et al, 2010;Khin et al, 2011). This conclusion was reached in the previous literature despite typical reliance on initial improvement on scale ratings rather than less readily achieved clinical remission, and despite growing evidence of publication bias toward underreporting of studies without significant drugplacebo differences (Ioannidis, 2008;Turner et al, 2008).…”

Section: Discussionsupporting

confidence: 80%

“…It is increasingly clear that drug-placebo differences in trials of antidepressants and other psychotropic agents have been declining (Gartlehner et al, 2008;Ioannidis, 2008;Kirsch et al, 2008;Tsapakis et al, 2008;Turner et al, 2008;Bridge et al, 2009;Masi et al, 2010;Khin et al, 2011;Vázquez et al, 2011;Yildiz et al, 2011a, b). In accord with recent findings in controlled treatment trials for mania (Yildiz et al, 2011a, b), a secular increase in sites and participants per trial was associated, selectively, with rising placeboassociated response rates, resulting in declining drugplacebo contrasts or effect-size (Figure 2; Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…Meta-analyses based on Stata metan programs, used random-effects modeling to limit effects of inter-trial variance; responder rates for each drug-placebo pair yielded pooled rate ratios (RRs) and rate differences (RDs) with their computed 95% confidence intervals (CIs) (Tsapakis et al, 2008;Yildiz et al, 2011a, b). Percentageimprovement in depression for drug-placebo pairs was compared by paired-t testing and averaged to provide overall estimates of response differences (RDs).…”

Section: Discussionmentioning

confidence: 99%

“…The superiority of most clinically employed antidepressants over placebos in controlled trials has been modest in adult patients diagnosed with major depression, even lower in juvenile depressed patients, and probably has declined in recent years (Walsh et al, 2002;Baldessarini, 2005;Cipriani et al, 2007;Papakostas et al, 2007;Gartlehner et al, 2008;Kirsch et al, 2008;Tsapakis et al, 2008;Bridge et al, 2009;Wooley et al, 2009;Masi et al, 2010;Pigott et al, 2010;Khin et al, 2011). Evident decline in superiority of drugs over placebos has occurred despite evidence of selective reporting of positive findings of potential commercial interest from therapeutic trials (Ioannidis, 2008;Turner et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Randomized, Placebo-Controlled Trials of Antidepressants for Acute Major Depression: Thirty-Year Meta-Analytic Review

Undurraga

Baldessarini

2011

Neuropsychopharmacol

212

168

View full text Add to dashboard Cite

Antidepressant-placebo response-differences (RDs) in controlled trials have been declining, potentially confounding comparisons among older and newer drugs. For clinically employed antidepressants, we carried out a meta-analytic review of placebo-controlled trials in acute, unipolar, major depressive episodes reported over the past three decades to compare efficacy (drug-placebo RDs) of individual antidepressants and classes, and to consider factors associated with year-of-reporting by bivariate and multivariate regression modeling. Observed drug-placebo differences were moderate and generally similar among specific drugs, but larger among older antidepressants, notably tricyclics, than most newer agents. This outcome parallels selective increases in placebo-associated responses as trial-size has increased in recent years. Study findings generally support moderate efficacy of clinically employed antidepressants for acute major depression, but underscore limitations of meta-analyses of controlled trials for ranking drugs by efficacy. We suggest that efficiency and drug-placebo differences may be improved with fewer sites and subjects, and better quality-control of diagnostic and clinical assessments.

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Randomized, Placebo-Controlled Trials of Antidepressants for Acute Major Depression: Thirty-Year Meta-Analytic Review

Undurraga

Baldessarini

2011

Neuropsychopharmacol

212

168

View full text Add to dashboard Cite

show abstract

“…• Guideline [33][34][35][36][47][48][49][50] • Not searched • Meta-analysis/systematic review [88][89][90][91][92] • RCT 85,[93][94][95][96] QI 6: Communication and documentation.…”

Section: Guideline Recommendationsmentioning

confidence: 99%

Evidence for the Management of Adolescent Depression

et al. 2013

View full text Add to dashboard Cite

Adolescent depression is a prevalent and disabling condition resulting in emotional suffering and social and educational dysfunction. Care for adolescent depression is suboptimal and could be improved through the development and use of quality indicators (QIs). This article reports on the development of a care pathway and QIs for the primary and specialty care management of adolescent depression from case identification through symptom remission. It presents evidence from a review of adolescent clinical practice guidelines and research literature to support QIs at critical nodes in the pathway, and describes implications for practice based on existing evidence. Barriers to measure development are identified, including gaps in empirical evidence, and a research agenda is suggested. Pediatrics 2013;132:e996-e1009

show abstract

A Randomized Controlled Trial of Risperidone, Lithium, or Divalproex Sodium for Initial Treatment of Bipolar I Disorder, Manic or Mixed Phase, in Children and Adolescents

Geller¹

2012

Arch Gen Psychiatry

212

167

View full text Add to dashboard Cite

Context There was a paucity of comparative pharmacological research for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents. Objective To investigate which medication to administer first to antimanic medication-naive subjects. Design, Setting, and Participants The Treatment of Early Age Mania (TEAM) study recruited 6- to 15-year-old children and adolescents with DSM-IV bipolar I disorder (manic or mixed phase) at 5 US sites from 2003 to 2008 into a controlled, randomized, no-patient-choice, 8-week protocol. Blinded, independent evaluators conducted all baseline and end-point assessments. Interventions Subjects received a titrated schedule of lithium, divalproex sodium, or risperidone. Medications were increased weekly only if there was inadequate response, and no dose-limiting adverse effects, to maximum doses of lithium carbonate (1.1-1.3 mEq/L), divalproex sodium (111-125 μg/mL), and risperidone (4-6 mg). Main Outcome Measures Primary outcome measures were the Clinical Global Impressions for Bipolar Illness Improvement-Mania and the Modified Side Effects Form for Children and Adolescents. Results There were 279 antimanic medication-naive subjects (mean [SD] age, 10.1 [2.8] years; 50.2% female) who had the following characteristics: 100% elated mood and/or grandiosity, 77.1% psychosis, 97.5% mixed mania, 99.3% daily rapid cycling, and mean (SD) mania duration of 4.9 (2.5) years. The mean (SD) titrated lithium level was 1.09 (0.34) mEq/L, and the mean (SD) divalproex sodium level was 113.6 (23.0) μg/mL. The mean (SD) titrated risperidone dose was 2.57 (1.21) mg. Higher response rates occurred with risperidone vs lithium (68.5% vs 35.6%; χ21=16.9, P<.001) and vs divalproex sodium (68.5% vs 24.0%; χ21=28.3, P<.001). Response to lithium vs divalproex sodium did not differ. The discontinuation rate was higher for lithium than for risperidone (χ21=6.4, P=.011). Increased weight gain, body mass index, and prolactin level occurred with risperidone vs lithium (F1,212=45.5, P<.001; F1,212=39.1, P<.001; and F1,213=191.4, P<.001, respectively) and vs divalproex sodium (F1,212=34.7, P<.001; F1,212=45.3, P<.001; and F1,213=209.4, P<.001, respectively). The thyrotropin level increased in subjects taking lithium (t62=11.3, P<.001). Conclusions Risperidone was more efficacious than lithium or divalproex sodium for the initial treatment of childhood mania but had potentially serious metabolic effects. Trial Registration clinicaltrials.gov Identifier: NCT00057681

show abstract

Efficacy of antidepressants in juvenile depression: meta-analysis

Cited by 131 publications

References 60 publications

Randomized, Placebo-Controlled Trials of Antidepressants for Acute Major Depression: Thirty-Year Meta-Analytic Review

Randomized, Placebo-Controlled Trials of Antidepressants for Acute Major Depression: Thirty-Year Meta-Analytic Review

Evidence for the Management of Adolescent Depression

A Randomized Controlled Trial of Risperidone, Lithium, or Divalproex Sodium for Initial Treatment of Bipolar I Disorder, Manic or Mixed Phase, in Children and Adolescents

Contact Info

Product

Resources

About