New generation antidepressants for depression in children and adolescents: a network meta-analysis

Hetrick, Sarah; Meader, Nicholas; Bailey, Alan P; Badcock, Paul B.; Moller, Carl I.; Cox, Georgina; Merry, Sally; McKenzie, Joanne E.

doi:10.1002/14651858.cd013674

Cited by 7 publications

(10 citation statements)

References 90 publications

(69 reference statements)

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“…54 However, there is conflicting evidence whether this leads to an increased risk of suicidality. 53,54 In our study, only 1 patient received fluoxetine less than 4 weeks at the time of the suicidal attempt. The data obtained in this study are not sufficient to infer causality or to determine whether the underlying disease or the drug therapy was responsible for the suicide attempts.…”

Section: Intoxications and Suicidalitymentioning

confidence: 92%

“…48,49 However, those drugs have been the subject of a controversial debate about a possible increase in suicidality in children and adolescents. [50][51][52][53] Especially after initiation, selective serotonin reuptake inhibitors are associated with an increased risk of antidepressant-induced activation. 54 However, there is conflicting evidence whether this leads to an increased risk of suicidality.…”

Section: Intoxications and Suicidalitymentioning

confidence: 99%

“…Nevertheless, our data strongly suggest that pediatric patients receiving psychotropic drugs should be monitored more closely to avoid suicide attempts as also recommended by a recent Cochrane review. 53…”

Section: Intoxications and Suicidalitymentioning

confidence: 99%

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Adverse Drug Reactions at Nonelective Hospital Admission in Children and Adolescents: Comparison of 4 Causality Assessment Methods

et al. 2022

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ObjectivesThis study aimed to compare assessment methods to determine adverse drug reactions (ADRs) at nonelective hospital admission in pediatric patients, to investigate the interrater reliability of assessment methods in pediatric care, and to analyze symptoms related to ADRs and (suicidal) drug intoxications.MethodsFor 1 year, the medical records of nonelective patients admitted to a university pediatric department were evaluated for potential ADRs using 4 assessments methods by 1 experienced rater. Krippendorff α was calculated from a sample of 14 patients evaluated by 4 experienced raters to determine interrater reliability.ResultsIn 1831 nonelective hospital admissions, 63.4% (1161 of 1831) of patients had received at least one drug before admission. We found a potential causal relationship between drugs and symptoms documented at admission and thus potential ADRs according to Naranjo in 23.3% (271 of 1161) of those patients, World Health Organization - Uppsala Monitoring Centre (WHO-UMC) in 22.5% (261 of 1161), Koh in 21.7% (252 of 1161), and Begaud in 16.5% (192 of 1161). The probability rating of the potential causal relationships varied considerably between the methods (Naranjo-Begaud, P < 0.01; Naranjo-Koh, P < 0.001; Koh-Begaud, P < 0.01; Begaud-WHO-UMC, P < 0.01). Acceptable interrater reliability (α ≥ 0.667) was only obtained for WHO-UMC (α = 0.7092). The most frequently identified definite ADR was sedation in 1.5% of all nonelective patients with medication before hospital admission. In 1.2% (22 of 1831) of all nonelective admissions, we found drug intoxications with suicidal intent.ConclusionsThe assessment methods showed a high variability in the determination of a potential causal relationship between drug and documented symptom, in the classification of the probability of ADRs, and suboptimal interrater reliability. Thus, their feasibility in pediatric patients is limited.

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Section: Intoxications and Suicidalitymentioning

confidence: 92%

Section: Intoxications and Suicidalitymentioning

confidence: 99%

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Adverse Drug Reactions at Nonelective Hospital Admission in Children and Adolescents: Comparison of 4 Causality Assessment Methods

et al. 2022

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“…Psychotropic drugs — antipsychotic, antidepressant, psychostimulant, anxiolytic, and sedative and hypnotic agents — can be prescribed for children and adolescents with mental disorders, including schizophrenia, attention deficit/hyperactivity disorder (ADHD), autism, depression, and anxiety. Although psychotropic drugs can benefit children and adolescents with mental disorders, their efficacy and safety in young people is debated 1,2 …”

mentioning

confidence: 99%

Dispensing of psychotropic medications to Australian children and adolescents before and during the COVID‐19 pandemic, 2013–2021: a retrospective cohort study

Wood

Ilomäki

Gould

et al. 2023

Medical Journal of Australia

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Objective To determine longitudinal patterns of dispensing of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic/sedative medications to children and adolescents in Australia during 2013–2021. Design Retrospective cohort study; analysis of 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. Participants, setting People aged 18 years or younger dispensed PBS‐subsidised psychotropic medications in Australia, 2013–2021. Main outcome measures Population prevalence of dispensing of psychotropic medications to children and adolescents, by psychotropic class, gender, and age group (0–6, 7–12, 13–18 years). Results The overall prevalence of psychotropic dispensing to children and adolescents was 33.8 per 1000 boys and 25.2 per 1000 girls in 2013, and 60.0 per 1000 boys and 48.3 per 1000 girls in 2021. The prevalence of psychotropic polypharmacy was 5.4 per 1000 boys and 3.7 per 1000 girls in 2013, and 10.4 per 1000 boys and 8.3 per 1000 girls in 2021. Prevalent dispensing during 2021 was highest for psychostimulants (boys, 44.0 per 1000; girls, 17.4 per 1000) and antidepressants (boys, 20.4 per 1000; girls, 33.8 per 1000). During 2021, the prevalence of dispensing was higher than predicted by extrapolation of 2013–2019 data for many classes, including antidepressants (boys: +6.1%; 95% CI, 1.1–11.1%; girls: +22.2%; 95% CI, 17.4–26.9%), and psychostimulants (boys: +14.5%; 95% CI, 8.0–21.1%; girls: +27.7%; 95% CI, 18.9–36.6%). The increases were greatest for girls aged 13–18 years (antidepressants: +20.3%; 95% CI, 16.9–23.7%; psychostimulants: +39.0%; 95% CI, 27.9–50.0%). Conclusions The prevalence of both psychotropic dispensing and psychotropic polypharmacy for children and adolescents were twice as high in 2021 as in 2013. The reasons and appropriateness of the marked increases in psychotropic dispensing during the COVID‐19 pandemic, particularly to adolescent girls, should be investigated.

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“…Guidelines recommend CBT as a first-line treatment for MDD in young people, with medication initiated if there is a poor response (Beyondblue., 2010;NICE, , 2019). The most recent evidence about antidepressants shows that, on average, there are only very small improvements in depression symptoms for those on antidepressants compared with those on placebo (Hetrick et al, 2020). There is also evidence that antidepressants increase the risk of suicide related behaviours.…”

mentioning

confidence: 99%

The experience of young people receiving cognitive behavioural therapy for major depression: A qualitative study

Ferguson

Rice

Gleeson

et al. 2022

Early Intervention Psych

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Aim Major depressive disorder (MDD) has far reaching impacts for young people, their families and society. Cognitive behavioural therapy (CBT) is one of the first‐line treatments for young people experiencing MDD; however, there is limited research examining how young people with MDD experience CBT. The aim of this study was to explore their experience and their views of this intervention. Methods We employed a qualitative research design, with semi‐structured interviews and thematic analysis. Eight participants aged between 17 and 24 years who received CBT for MDD in a randomized controlled trial were recruited. Results Five themes were identified: the importance of relationship with clinician; the range of useful components within CBT; the ability for CBT to accommodate different techniques and presenting issues; the importance of checking in with clients during the process of therapy; and the impacts of MDD on therapy. Conclusions The findings highlight the importance of clinicians having a youth friendly and collaborative approach that allows a modular delivery of a range of CBT techniques to suit the client's presenting issue and formulation. There is a need to continually check how young people are responding to interventions, and to be aware of potential cognitive deficits and adjust therapy accordingly. This is a small study that provides insight into how young people with MDD experience CBT and avenues to explore for tailoring provision of CBT to enhance the therapeutic experience for this population.

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New generation antidepressants for depression in children and adolescents: a network meta-analysis

Cited by 7 publications

References 90 publications

Adverse Drug Reactions at Nonelective Hospital Admission in Children and Adolescents: Comparison of 4 Causality Assessment Methods

Adverse Drug Reactions at Nonelective Hospital Admission in Children and Adolescents: Comparison of 4 Causality Assessment Methods

Dispensing of psychotropic medications to Australian children and adolescents before and during the COVID‐19 pandemic, 2013–2021: a retrospective cohort study

The experience of young people receiving cognitive behavioural therapy for major depression: A qualitative study

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