1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Benefits of Antidepressants Appear to Outweigh Risks in Children and Adolescents

Slightly increased risk for suicidal ideation with antidepressant use, but even greater benefits

Previous analyses showing an increased risk for suicidal ideation in children and adolescents taking antidepressants led the FDA to require a boxed warning on labels of all antidepressants. To further assess the risks and benefits of antidepressants, researchers conducted a meta-analysis of 27 clinical trials of antidepressant use (mostly SSRIs) in pediatric patients for major depressive disorder (MDD, 15 trials), obsessive-compulsive disorder (OCD, 6 trials), and other anxiety disorders (6 trials).

In pooled analyses, response rates in the drug and placebo groups were 61% versus 50% for patients with MDD, 52% versus 32% for patients with OCD, and 69% versus 39% for patients with other anxiety disorders. After minor statistical adjustments, the numbers needed to treat to benefit one patient were 10, 6, and 3 for MDD, OCD, and other anxiety disorders, respectively. The absolute difference in risk for suicidal ideation between antidepressant and placebo groups was 0.7% (number needed to harm, 143). No completed suicides occurred in any trial.

Comment: These data provide a more balanced picture of the risks and benefits of antidepressant use in pediatric patients. The results support their use in children and adolescents by knowledgeable and experienced clinicians for appropriate diagnoses and with careful monitoring. The relatively greater efficacy in patients with anxiety disorders compared to those with MDD is worthy of further study.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine May 1, 2007

Citation(s):

Bridge JA et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials. JAMA 2007 Apr 18; 297:1683-96.

• Original article (Subscription may be required)
• Medline abstract (Free)