Newer generation antidepressants for depressive disorders in children and adolescents

Abstract

Background Depressive disorders are common in young people and are associated with significant negative impacts. Newer generation antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are often used, however evidence of their effectiveness in children and adolescents is not clear. Furthermore, there have been warnings against their use in this population due to concerns about increased risk of suicidal ideation and behaviour. Objectives To determine the efficacy and adverse outcomes, including definitive suicidal behaviour and suicidal ideation, of newer generation antidepressants compared with placebo in the treatment of depressive disorders in children and adolescents. Search methods For this update of the review, we searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to October 2011. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (the Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). We searched clinical trial registries and pharmaceutical company websites. We checked reference lists of included trials and other reviews, and sent letters to key researchers and the pharmaceutical companies of included trials from January to August 2011. Selection criteria Published and unpublished randomised controlled trials (RCTs), cross-over trials and cluster trials comparing a newer generation antidepressant with a placebo in children and adolescents aged 6 to 18 years old and diagnosed with a depressive disorder were eligible for inclusion. In this update, we amended the selection criteria to include newer generation antidepressants rather than SSRIs only. Newer generation antidepressants for depressive disorders in children and adolescents (Review)

Mood disorders in childhood and adolescence

“…29 In respect to the effectiveness and safety of pharmacological treatment options for child and adolescent depression, the systematic review of the literature highlighted the high heterogeneity among available studies, but suggested that fluoxetine should be the treatment of choice if pharmacological treatment is considered. 30 The same authors also reviewed the available evidence on interventions for preventing relapse and recurrence of depression in children and adolescents,…”

Ten years after the FDA black box warning for antidepressant drugs: a critical narrative review

“…Participants had limited information about the risk of bias, high dropout rates and issues regarding measurement instruments and the clinical usefulness of outcomes, which were often defined differently across trials. The authors concluded that: 1) Due to the methodological limitations of the included trials in terms of internal and external validity, the results must be interpreted with caution; 2) The size and clinical meaningfulness of statistically significant results are uncertain; 3) Fluoxetine might be the medication of choice if a decision to use medication is agreed given the guideline recommendations 26 . On the other hand, an independent meta-analysis, that included 39 studies of AD, did not reveal any significant difference in the ideation or risk of attempted suicide, where one in 147 patients would demonstrate an increased risk 27 .…”

Childhood Depression As Emerging Public Health Problem: A Systematic Review

“…Known as "third generation antidepressants", these medications include selective norepinephrine reuptake inhibitors, norepinephrine reuptake inhibitors, norepinephrine dopamine reuptake inhibitors, norepinephrine dopamine disinhibitors, and tetracyclic antidepressants [236,237]. To date, evidence does not clearly answer questions about the effectiveness and safety of these newer antidepressants [236,237]; clearly, further research is indicated [237].…”