Researchers review the antidepressants currently used for psychiatric disorders among children and their possible adverse effects.
Depressive disorders, anxiety disorders, obsessive-compulsive disorders (OCD), and posttraumatic stress disorders (PTSD) are psychiatric disorders that are often seen among children and adolescents. A recent systematic review and meta-analysis carried out in the US and published in JAMA Psychiatry have set out to examine the use of certain antidepressants for psychiatric disorders among children and adolescents.
Currently, first-line treatments for this young subgroup of patients are antidepressants called selective serotonin reuptake inhibitors, also known as SSRIs. Another group of antidepressants is called serotonin-norepinephrine reuptake inhibitors, also known as SNRIs. Due to a lack of compelling evidence, SNRIs considered second and third-line treatment options. The review investigated the efficacy and safety of these antidepressants, compared to a placebo, for psychiatric disorders in children and adolescents.
The results obtained from the review of 36 trials, including 6,778 participants, demonstrated that SSRIs and SNRIs provide better treatment than placebo for children and adolescents diagnosed with these psychiatric disorders. However, the authors of the review state that the overall difference between drug and placebo is small and differs between disorders, with a larger response seen in anxiety than depression, particularly with the SSRIs. This variability in drug-placebo response is attributed to the fact that the response to placebo was higher in the pediatric depression groups.
The authors explain that this difference between SSRIs, SNRIs, and placebo in children and adolescents with depression could be due to the lack of clearly defined criteria for the diagnosis of depression, which is further complicated by the fact that there is a high rate of comorbidity of depression with other mental disorders such as anxiety. In addition to this, the patients with OCD demonstrated a low response to both drug and placebo treatments when compared to both anxiety and depression.
This review found that patients receiving an antidepressant reported more adverse events and discontinuation of treatment than those receiving placebo. These results correspond to the results from other meta-analysis studies conducted in the past, in which increased suicide and suicide attempts were observed in children and adolescents receiving SSRIs and SNRIs. These results highlight the reservations surrounding the safety of antidepressants in children and adolescents.
To conclude, the authors state the main findings of this systematic review and meta-analysis are:
- The similar response rate for depression and anxiety deserves subsequent investigation, which could lead to a change in current prescribing guidelines.
- The difference in responses to drug treatments and placebo between OCD and anxiety/depression strongly suggests that there are major differences in the causes and development (or etiology) of the disorders. Hence, additional measures might be necessary for pediatric patients with OCD.
- Additional research is needed in order to establish factors that may affect the efficacy of the SSRI’s and SNRI’s in children and adolescents.
- The variability in assessing and reporting adverse events needs to be reviewed in order to establish a standardized method for reporting these adverse events.
This last finding is of paramount importance as the risk of life-threatening events in this young group of patients needs to be addressed in order to determine treatment and treatment combinations that are the most appropriate for patients. Psychiatric disorders among children and adolescents need to be thoroughly studied to improve outcomes and minimise risks. Therefore, further research is required to minimise the risk of adverse events and to improve the clinical outcomes for these disorders.
Written by Jade Marie Evans, MPharm, Medical Writer
Reference: Cosima L et al . (2017). Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents A Systematic Revie. Available: http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2652447?resultClick=1. Last accessed 01/09/2017.