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The Most Commonly Used Antidepressants For Young People Don’t Work

BEC CREW
7 JUL 2016

The most commonly available antidepressants are not only ineffective in young people, they can actually be dangerous, with a major review finding children and teens with depression are better off taking nothing at all.

 

The findings have "disturbing implications" for treating major depression in children, an Australian psychiatrist has warned, with one drug being linked to an increased risk of suicidal thoughts and suicide attempts compared to a placebo.

The study, led by Oxford University psychiatrist Andrea Cipriani, analysed the results of 34 clinical trials involving 5,260 participants (average age 9 to 18 years) who had moderate to severe symptoms and had been diagnosed with major depression. 

The kids had been randomly assigned a particular antidepressant or a placebo to take for eight weeks straight, on average. The antidepressants tested were amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine.

The drugs were ranked in terms of efficiency (change in depressive symptoms and response to treatment), tolerability (discontinuation due to unwanted side effects), acceptability (discontinuation due to any cause), and associated serious harms (suicidal thoughts and attempts). 

The review found that only one of the 14 drugs was actually effective at relieving symptoms of depression - fluoxetine, better known as Prozac, which is the most widely prescribed antidepressant for young people in the UK.

 

Venlafaxine, on the other hand, (marketed as Effexor), appeared to actually increase the risks of young people experiencing suicidal thoughts and attempts, compared to the placebo and five other antidepressants. The researchers have cautioned that due to the lack of reliable data, they were not able to comprehensively assess the risk of suicidality for all 14 drugs.

"The elevated risk of suicide has already been recognised before," Alyssa Navarro reports for Tech Times. "In 2004, the FDA placed several antidepressants under a black box warning for patients under 24 years old after finding evidence that suggested a suicide link."

Navarro also points to a study released earlier this year that found certain antidepressants could lead to a higher risk of aggression, as well as increased risk of suicidal thoughts and attempts in young users.

All up, apart from fluoxetine, the 13 drugs did not show any signs of being better than the placebo in treating symptoms of major depression, and the researchers concluding that given the pros and cons laid out by these trials, antidepressants "do not seem to offer a clear advantage for children and adolescents" with major depression.

Jon Jureidini, an Australian child psychiatrist from the University of Adelaide in South Australia, wrote in a commentary piece that the review's findings had "disturbing implications for clinical practice", and added that it might not be worth the risk to prescribe anything at all. 

"Only if the discounted benefit outweighs the boosted harm should the treatment be prescribed," he said. "For antidepressants in adolescents, this equation will rarely favour prescribing; in younger children, almost never."

With major depressive disorder now considered "common" in children and adolescents around the world, affecting around 3 percent of children aged 6 to 12 years and about 6 percent of teenagers aged 13 to 18 years, it's crucial we get the treatment right.

Considering the risks of prescribing antidepressants, Jureidini and Cipriani recommend psychotherapy as the first line of defence, well before drugs are considered.

The study mirrors what's going on in the treatment of major depression in adults, with researchers turning to psychoactive drugs like ketamine to succeed where traditional drugs have failed. One thing's for sure, right now, people with depression aren't getting the treatment they need, so hopefully with a better understanding of the disorder, we can offer something better.

The study has been published in The Lancet.