NYAPRS Note: NYAPRS strongly encourages informed choice in taking medications. Many in our community, including me, take them with good results; many have very troubling side effects and increased suicidal thoughts; many others reject traditional diagnoses and treatments. Note the author's cautionary end note: "the authors suggest that parents and medical professionals monitor children and adolescents taking antidepressants closely, regardless of the drug chosen."Also, it's been long clear that we need independent scientific research on the actual impact of these medications.
Antidepressant Drugs Are Ineffective for Children and Teens Suffering Major Depression, A New Study Says By Nicole Lyn Pesce New York Daily News Wednesday, June 8, 2016
Most drugs treating kids and teens suffering major depression are majorly ineffective - and even dangerous.
A new Lancet study released Wednesday night analyzed 34 trials for 14 antidepressants involving 5,260 patients ages 9 to 18. It found that only one drug - fluoxetine, better known by the brand names Prozac and Sarafem - relieved severe depression symptoms better than the sugar-pill placebo. Worse, the kids taking venlafaxine (also known by brand names Effexor, Lanvexin, Viepax and Trevilor) actually showed an increased risk of suicidal thoughts and attempts.
"When considering the risk-benefit profile of antidepressants in the acute treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents," concludes the report. "Fluoxetine is probably the best option to consider when a pharmacological treatment is indicated."
Medicating children and adolescents suffering depressive disorder has long been controversial. The Food and Drug Administration even slapped a black box warning - its strictest - against the use of antidepressants in young people up to age 24 in 2004 over concerns about increased risk of suicides - although no children in the FDA's sweep actually killed themselves.
But despite the FDA warning, the use of antidepressants among U.S. and U.K. children and teenagers up to age 19 has continued to increase. Yet no one has cross-examined the published and unpublished trials of how many of these drugs affect children, until this report.
Researchers warn that they are just scratching the surface, however, since the lack of individual-level data from trials makes it difficult to get accurate estimates of just how these drugs affect patients, and how many become suicidal.
"Delay in implementing responsible data sharing policies has negative consequences for medical research and patient outcomes, as demonstrated by this study," wrote lead author Dr. Andrea Cipriani at the University of Oxford in the report.
His analysis of the 34 trials compared the effects of 14 antidepressants in young people with major depression up to the end of May 2015, including the drugs amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline and venlafaxine. His team ranked the drugs by how well they treated depressive symptoms, whether discontinuing the drug caused adverse side effects, and whether the drugs were associated with suicidal thoughts and attempts.
The results? Only fluoxetine (Prozac, Sarafam) showed benefits that outweighed the risks. Nortriptyline was less effective than seven other antidepressants and the placebo. Imipramine, venlafaxine and duloxetine were the least tolerable, with many patients discontinuing them. And most troubling, venlafaxine was linked with increased suicidal thoughts or attempts compared with the placebo and five other antidepressants.
But the authors warn that this doesn't paint a full picture, since a lack of reliable data did not allow them to fully assess the risk of suicidality for all drugs. That's partly because 65% of the trials they reviewed were funded by pharmaceutical companies, so almost one third were rated as high risk of bias, and another 59% were rated moderate risk of bias. So those reports could have overestimated how well their drugs worked, and minimized the side effects.
Dr. Jon Jureidini at the University of Adelaide in Australia warned that many more suicidal events might have come to light if the individual patient data had been available. "The effect of misreporting is that antidepressants, possibly including fluoxetine, are likely to be more dangerous and less effective treatments than has been previously recognized," he wrote, "so there is little reason to think that any antidepressant is better than nothing for young people."
The authors suggest that for now, parents and medical professionals monitor children and adolescents taking antidepressants closely, regardless of the drug chosen.