Benefits of antidepressants for children and teens with depression or anxiety disorders may outweigh risks

A review of previous studies indicates that the benefits of antidepressants for children and teens with depression or anxiety disorders may outweigh their risks, and that the increased risk for suicidal thoughts and attempts from using these medications is not statistically significant, according to an article in the April 18 issue of JAMA.

Previous research has indicated that the usage of antidepressants among children and adolescents is associated with an increased risk for suicidal behavior and thoughts, and resulted in the issuing of mandated label warnings on pediatric antidepressant medications by the FDA, according to background information in the article.

Jeffrey A. Bridge, Ph.D., of The Ohio State University, Columbus, and colleagues conducted a review and meta-analysis of randomized controlled trials involving the pediatric usage of antidepressants for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and non-OCD anxiety disorders, and included recent trials that had not been incorporated into previous analyses, to assess their benefits and effect on risk of suicidal thoughts and attempts. The researchers conducted a search for studies through 2006 and identified and included 27 pediatric trials for their analysis: MDD (n = 15), OCD (n = 6), and non-OCD anxiety disorders (n = 6).

The researchers found: "Consistent with the analyses of the FDA, we found evidence of an overall small but increased risk of treatment-emergent suicidal ideation/suicide attempt. However, the pooled random-effects risk differences of suicidal ideation/suicide attempt for each indication were all less than 1 percent. There were no completed suicides in these trials."

"This meta-analysis of all available randomized clinical trials of antidepressant treatment of pediatric MDD, OCD, and non-OCD anxiety disorders shows evidence of efficacy for all three indications, although the effects were strongest for non-OCD anxiety disorders, intermediate for OCD, and more modest in MDD," the authors write. Adolescents appeared to respond better than children to antidepressants in trials of both depression and anxiety.

"Some may argue that any risk of suicidal ideation/suicide attempt cannot possibly justify treatment with antidepressants for children and adolescents. Instead, we believe that the strength of evidence presented here supports the cautious and well-monitored use of antidepressant medications as one of the first-line treatment options, with the recognition that efficacy appears greatest for non-OCD anxiety disorders, intermediate for OCD, and more modest for MDD. Since the choice of treatment should be the result of a collaborative discussion between clinician, family, and patient, the information presented in this report should allow for an informed evaluation of the potential benefits and risks of these medications vs. no treatment and provide a framework for their comparison with nondrug treatments as well," the researchers conclude.