Major depressive disorder is one of the most common mental disorders in children and adolescents. However, it is still unclear whether pharmacological interventions should be used in this population, and if so, which drugs. The findings of a study whose purpose was to compare and rank antidepressant treatments in cases of major depressive disorder in young people were recently published in the Lancet journal.
More on a similar matter
The study was carried out in the format of a literature review and meta-analysis. In the literature review, the researchers searched the PubMed databases,JCochrane Library, Web of Science, Embase, CINAHL, PsychINFO, LiLACS, websites of regulatory authorities and international registries to find published or unpublished double-blind clinical trials up to May 31, 2015 that examined acute treatments for major depressive disorder in children and adolescents. The meta-analysis included studies that included treatment with amitriptyline, citalopram, clomipramine, desipramine, duloxetine, ezitalopram, fluoxetine, imipramine, mirtazapine, nafazodone, nortiptiline, paroxetine, sertraline and nalapaxine. Studies that recruited participants with treatment-resistant depression, treatment that lasted less than 4 weeks, or studies that had a total sample size of less than 10 participants were excluded from the final analysis. The main outcomes in the study included efficacy (the change in depression symptoms) and tolerability (discontinuation of treatment due to side effects). The researchers performed a meta-analysis with a pair-wise approach using the random effect model and then conducted a meta-analysis with a network meta-analysis approach with random effects within a Bayesian framework. The researchers evaluated the quality of the evidence used by the researchers in each network using the GRADE framework.
During the literature review, the researchers found that 34 clinical trials met the conditions for inclusion in the final analysis. In those experiments, 5,260 participants and 14 antidepressant treatments were included. In terms of effectiveness, the results of the study showed that the only treatment that was significantly more effective compared to Invo was fluoxetine (standardized mean difference – -0.51, 95% confidence interval -0.99-(-0.03)). Also in terms of tolerability, it was found that treatment with fluoxetine was superior to duloxetine (odds ratio – 0.31, 95% confidence interval – 0.13-0.95) and imipramine (odds ratio – 0.23, 95% confidence interval – 0.04-0.78). It was also found that in relation to placebo, among patients who received treatment with imipramine, venlafaxine and duloxetine, a higher rate of treatment discontinuation due to side effects was demonstrated (odds ratio – 5.49, 95% confidence interval – 1.96-20.86; odds ratio – 3.19, 95% confidence interval – 1.01-18.70 and odds ratio 2.80, 95% confidence interval – 1.20-9.42, respectively). In terms of heterogeneity, it was found that the global I2 values were 33.21% for efficacy and 0% for tolerability.
This study shows that when considering the profile of the benefit in relation to the risk of an antidepressant trip as an acute treatment for major depression, no clear advantage can be found in the child and adolescent population. However, the best preference is probably fluoxetine when pharmacological intervention is indicated.
source:
Cipriani A, Zhou X, Del Giovane C, Hetrick SE, Qin B, Whittington C, Coghill D, Zhang Y, Hazell P, Leucht S, Cuijpers P, Pu J, Cohen D, Ravindran AV, Liu Y, Michael KD, Yang L, Liu L, Xie P. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet. 2016 Aug 27;388(10047):881-90. doi: 10.1016/S0140-6736(16)30385-3. Epub 2016 Jun 8. PMID: 27289172.