Most available antidepressants are ineffective and may even be unsafe for children and teenagers suffering from major depression, a new study has warned.
An international team of researchers carried out the most comprehensive comparison of commonly prescribed antidepressant drugs so far and found that out of 14 antidepressant drugs, only fluoxetine was more effective at relieving the symptoms of depression than placebo.
Taking venlafaxine was linked with an increased risk of engaging in suicidal thoughts and attempts compared with placebo and five other antidepressants, researchers said.
“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,” said Peng Xie from The First Affiliated Hospital of Chongqing Medical University in China.
“We recommend that children and adolescents taking antidepressants should be monitored closely, regardless of the antidepressant chosen, particularly at the beginning of treatment,” said Peng.
Major depressive disorder is common in children and adolescents, affecting around three per cent of children aged six to 12 years and about six per cent of teenagers aged 13 to 18 years, researchers said.
Scientists including researchers from University of Oxford in the UK did a systematic review and network meta-analysis of all published and unpublished randomised trials comparing the effects of 14 antidepressants in young people with major depression up to the end of May last year.
They ranked antidepressants by efficacy (change in depressive symptoms and response to treatment), tolerability (discontinuation due to adverse events), acceptability (discontinuation due to any cause), and associated serious harms (for example suicidal thoughts and attempts).
Analysis of 34 trials involving 5,260 participants (average age 9 to 18 years) showed that the benefits outweighed the risks in terms of efficacy and tolerability only for fluoxetine, researchers said.
Nortriptyline was less efficacious than seven other antidepressants and placebo.
Imipramine, venlafaxine, and duloxetine had the worst profile of tolerability, leading to significantly more discontinuations than placebo, researchers said.
Venlafaxine was linked with an increased risk of engaging in suicidal thoughts or attempts compared with placebo and five other antidepressants, they said.
“The effect of misreporting is that antidepressants, possibly including fluoxetine, are likely to be more dangerous and less effective treatments than has been previously recognised, so there is little reason to think that any antidepressant is better than nothing for young people,” said Jon Jureidini from University of Adelaide in Australia.
The findings were published in the journal Lancet.