DD HEALTH: MOST available antidepressants are ineffective for children and teenagers with major depression, and some may be unsafe, according to a study.
Only one drug, fluoxetine, was found to work better at relieving the symptoms of depression than a look-alike placebo with no active ingredients, said the study.
Another drug, venlafaxine, was linked with an increased risk of suicidal thoughts and attempts compared with placebo and five other antidepressants, it reported.
The study, published this week, reported that major depressive disorder is common in children and adolescents, affecting around 3% of children aged 6 to 12 years and about 6% of teenagers aged 13 to 18 years.
Psychological treatments are recommended as the first-line treatment for depression in many clinical guidelines, and in 2004 the US Food and Drug Administration (FDA) black box warning against the use of antidepressants in young people up to 24 years because of concern about increased risk of suicidality.
However, use of antidepressants has slowly increased between 2005 and 2012.
The report stated, as an example, the proportion of US children and teenagers (aged 0-19 years) taking antidepressants increased from 1.3% to 1.6%, and in the UK from 0.7% to 1.1% .
Sertraline is the most widely prescribed antidepressant in the USA and fluoxetine is the most common in the UK.
“The balance of risks and benefits of antidepressants for the treatment of major depression does not seem to offer a clear advantage in children and teenagers,” said co-author Peng Xie from The First Affiliated Hospital of Chongqing Medical University in China.
The international team of researchers recommended that youths taking such medications be monitored closely regardless of the antidepressant chosen, particularly at the beginning of treatment.
They also called for more transparency and information sharing.
“We can’t be completely confident about the accuracy of the information contained in published and unpublished trials,” lead author Andrea Cipriani at the University of Oxford said in a statement.
“Delay in implementing responsible data sharing policies has negative consequences for medical research and patient outcomes.”
The study covered 34 clinical trials involving 5,260 participants, aged 9 to 18.
Two-thirds of the trials were funded by pharmaceutical companies.
In a comment, also in The Lancet, Jon Jureidini from the University of Adelaide in Australia questioned whether the lack of data about individual patients obscured the true number of suicidal events.
“Claims that appropriate access to such data is incompatible with intellectual property constraints and patient privacy must be strongly resisted.”
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