A Meta-Analysis of Randomized Placebo Controlled Trials of Antidepressant Medications in Depressed Children: Do the Benefits Justify the Risks?

Amanda Drews, David Antonuccio, Irving Kirsch
Depression affects a substantial portion of children and adolescents. Although most youngsters do not receive any intervention, the introduction of antidepressant medications has drastically affected the manner in which depressed children and adolescents are treated. Important questions have been raised about both the empirical support for and safety of using SSRIs in this population. Thus, the goal of the current study was to quantify the actual benefit of antidepressant medication to children
more » ... ication to children and adolescents over and above the benefit of placebo. We searched three electronic databases (MEDLINE, PubMed, and PsycINFO) using the search terms "antidepressant" and "child[ren]" or "adolescents." Our search yielded 14 published antidepressant trials. Another 5 unpublished trials were found on the MHRA website. Within the 19 studies, we evaluated 11 SSRI-placebo comparisons and 9 tricyclic-placebo comparisons. A statistically significant difference in depressive symptoms favoring the medication condition was reported in 1 of the 9 tricyclic-placebo comparisons, 5 of the 6 published SSRI-placebo comparisons, and 1 of the 5 unpublished SSRI-placebo comparisons. It also was determined that 84% of the response to the medications examined in these studies was duplicated by placebo, leaving a maximum of 16% attributable to a true drug effect. Results suggestive of an overall benefit of SSRI medications compared to placebo for children and adolescents should be interpreted with caution given widely held concerns about publication biases toward positive medication results, high rates of placebo response, and lack of documented clinical (as opposed to statistical) advantage of such medications. Nevertheless, instead of telling parents of depressed youngsters what to do, providers may do well to consider thoughtfully and honestly educating parents (and their children) about benefits and risks associated with both medication and non-medication treatments and letting them decide for themselves how to proceed in the care of their children.