Although antidepressants are prescribed to millions of children and adolescents, the drugs do not offer any clear benefit to them and can boost the risk of suicide among users.
That’s the consensus of a new analysis published in the British medical journal The Lancet, which examined the results of 34 trials that included 5260 children and teens and 14 antidepressants.
And the researchers’ main conclusion: “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.”
Among all the antidepressants examined, only Prozac (fluoxetine), one of the first SSRIs (selective serotonin reuptake inhibitors) to hit the market, was found to be effective in this population, albeit the effect was rather modest.
Perhaps the most disturbing results from the meta-analysis had to do with side effects associated with the drugs. People on antidepressants are at risk for an array of side effects, including weight gain, anxiety and decreased sex drive.
The most severe side effects occurred with Effexor (venlafaxine), which was linked to an increased risk of suicide compared to placebo and 5 other antidepressants. Since 2004, the FDA has mandated that a “black box” warning – the most severe issued by the agency – be placed on the labeling for antidepressants noting the risk of suicide in young people associated with the drugs.
Patients who were given Effexor, Cymbalta (duloxetine) and Tofranil (imipramine) were more likely to quit taking the medications because they couldn’t stand the side effects compared to those taking a placebo.
The frequency of side effects may actually have been under-reported since, as the authors noted, many of the studies included in the meta-analysis were funded by pharmaceutical companies, which have been known to use poorly designed trials as well as selective disclosure of results.
Jon Jureidini, MD, a child psychiatrist with the University of Adelaide, Australia, noted in an editorial accompanying the article that he believes there is “little reason to think that any antidepressant is better than nothing for young people.”
“Prescribing might help the doctor feel like he or she is doing something, or help parents feel that something is being done, but the adolescent might feel it to be dismissive of their distress,” he added.