The impact of the efficacy and the safety warnings of antidepressants in the treatment of childhood depression. Changes in patterns of use and scientific evidences

Abstract

Introduction

Childhood depression is a cause of substantial morbidity and mortality in this population. Although antidepressants are used frequently for the treatment of this disorder, there has been recent controversy about their efficacy and safety in this population.

Objective

Providing updated information from the scientific point of view on some burning issues in relation to the prescription of antidepressants in childhood depression.

Methods

It has been made a review of the recent studies which have been published about the safety and efficacy of antidepressants, and the consequences of the warnings given by Regulatory Agencies on health care professionals to prescribe antidepressants for children.

Results

Impact of Safety Warnings: there has been a decrease in prescribing antidepressants and an increased suicide in this population since the FDA and EMA warnings announced an increased risk of suicide with pediatric antidepressant agents versus placebo. This is not possible to extract it because of causal relations. Effectiveness: nine of the sixteen controlled trials published between 1990 and 2010 provide evidence of effectiveness versus placebo in the treatment of major depressive disorder (MDD) in pediatric population (three for fluoxetine, two for sertraline, one for citalopram, two for escitalopram, and one for venlafaxine).

Conclusions

The antidepressant studies in children and adolescents have significant and methodological limitations that prevent getting conclusive findings. It is required further studies to determine which subgroups of patients and what drugs there have a risk / benefit ratio favorable, because no treatment can lead to serious damage in depressed children and adolescents.