MOST AVAILABLE ANTIDEPRESSANTS are ineffective – and some may even be unsafe, for children and teenagers with major depression – a new study has found.

The findings indicate that, out of 14 antidepressant drugs, only fluoxetine (also known as Prozac) was more effective at relieving the symptoms of depression than a placebo.

Taking the drug venlafaxine was linked with an increased risk of engaging in suicidal thoughts and attempts, compared with a placebo and five other antidepressants.

“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,” commented co-author Professor 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.

Increased risk of suicidality

Major depressive disorder is common in children and adolescents, affecting around 3% of children aged six 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) issued a 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 most commonly prescribed antidepressants in Ireland include escitalopram, citalopram sertrealine, fluoxetine and paroxetine. Fluoxetine is the most common in the UK.

The research, published in The Lancet today, points out that the true effectiveness and risk of serious harms remains unclear due to the small number and poor design of clinical trials assessing these drugs, and the selective reporting of findings.

Misreporting

Researchers analysed 34 trials involving 5,260 participants aged nine to 18.

• The drug nortriptyline was found to be less effective than seven other antidepressants and a placebo.
• Imipramine, venlafaxine and duloxetine had the worst profile of tolerability.
• Venlafaxine was linked with an increased risk of engaging in suicidal thoughts or attempts compared with placebo and five other antidepressants.

The authors warned that due to the lack of reliable data, it was not possible to comprehensively assess the risk of suicidality for all drugs.

Some 65% of the trials had been funded by pharmaceutical companies and ten of the trials were rated as high risk of bias.

Dr Jon Jureidini of the University of Adelaide in Australia commented that the effect of misreporting is that antidepressants are likely to be more dangerous and less effective treatments than previously recognised.

He said this means there is “little reason to think any antidepressant is better than nothing for young people.”

 If you need to talk, contact:

• Samaritans 116 123 or email jo@samaritans.org
• Console 1800 247 247 – (suicide prevention, self-harm, bereavement)
• Aware 1800 80 48 48 (depression, anxiety)
• Pieta House 01 601 0000 or email mary@pieta.ie – (suicide, self-harm)
• Teen-Line Ireland 1800 833 634 (for ages 13 to 19)
• Childline 1800 66 66 66 (for under 18s)

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