Most antidepressants 'ineffective for youngsters'

9th June 2016 - Most available antidepressants are ineffective for children and teenagers who have severe depression, according to a study in the medical journal The Lancet.

Chinese researchers found that out of 14 antidepressants, only fluoxetine, frequently known by its brand name Prozac, was more effective for young people when compared to a placebo drug.

The study also found that some antidepressants may be unsafe for people in this age group.
 

Depression in young people

Major depression is common in children and adolescents, affecting around 3% of children aged 6 to 12 and 6% of teenagers.

Depression can impact on all areas of a young person's life, including school, friendships, families and social activities. It is also associated with increased risk of self-harm and suicide and can lead to mental health problems and difficulties later in life.

Antidepressant use has been increasing in recent years, with fluoxetine the most popular choice in the UK.

The latest study reviewed 34 trials involving 5,260 participants aged 9 to 18.

The data showed that the benefits of prescribing fluoxetine outweighed the risks, but the same could not be said of other antidepressants.

Imipramine, venlafaxine and duloxetine were the least tolerated and were most likely to lead to patients stopping taking them.

Venlafaxine was linked with an increased risk of engaging in suicidal thoughts or attempting suicide compared with placebo and 5 other antidepressants. However, the authors caution that a lack of reliable data means it is not possible to reliably assess the link between antidepressant medication and suicidal tendencies for all drugs.
 

Close monitoring

In a statement, co-author Professor Peng Xie from The First Affiliated Hospital of Chongqing Medical University says: "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, with probably only the exception of fluoxetine.

"We recommend that children and adolescents taking antidepressants should be monitored closely, regardless of the antidepressant chosen, particularly at the beginning of treatment."
 

CBT

Professor Shirley Reynolds, director of the Charlie Waller Institute at the University of Reading, says the study is "a comprehensive and careful review of evidence". She points out in a statement: " NICE [the National Institute of Health and Care Excellence] guidance recommends caution in the use of anti-depressant medication for children and young people. It specifically states that the only anti-depressant that should be prescribed to anyone under 18 years is fluoxetine. It also states that fluoxetine should only be prescribed by a specialist child and adolescent psychiatrist and the young person must closely supervised throughout treatment.

"For most children and young people with depression NICE recommends treatment using psychological therapies. Specific psychological therapies including cognitive behaviour therapy (CBT) and interpersonal therapy are recommended."

Dr Bernadka Dubicka, vice chair of the Faculty of Child and Adolescent Mental Health at the Royal College of Psychiatrists, says in a statement: "We agree with the authors’ conclusions that antidepressants should be used judiciously, monitored carefully, and the risks and benefits assessed in each individual case.

"However, in those young people with a highly impairing and potentially life-threatening depressive disorder, where non-pharmacological interventions have not been successful, then pharmacological treatment remains an important treatment option."