Basel, Switzerland—While antidepressants are more effective than placebos for children and adolescents, the difference is actually quite small for some mental health disorders, according to a new study.
A report in JAMA Psychiatry notes that finding is important because use of the drugs is frequently accompanied by side effects, sometimes as serious as suicidal behavior.
Background information in the study indicates that the most common mental disorders in children and adolescents are anxiety disorders (AD), depressive disorders (DD), obsessive-compulsive disorder, and posttraumatic stress disorder. Children and adolescents are often treated with psychotherapy together with newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
To look at the placebo effect on the efficacy of antidepressants, researchers from the University of Basel in Switzerland and Harvard Medical School conducted a meta-analysis of data from more than 6,500 patients across 36 drug trials.
Results indicate that antidepressants have a greater specific effect on anxiety disorders compared to depressive disorders, where placebos have a stronger effect.
Overall, analysis indicated that SSRIs and SNRIs were significantly more beneficial compared with placebo, yielding a small effect size (g = 0.32; 95% CI, 0.25-0.40; P <.001). Compared with participants receiving placebo, patients receiving an antidepressant reported significantly more treatment-emergent adverse events (RR, 1.07; 95% CI, 1.01-1.12; P = .01 or RR, 1.49; 95% CI, 1.22-1.82; P <.001, depending on the reporting method), severe adverse events (RR, 1.76; 95% CI, 1.34-2.32; P <.001), and study discontinuation due to adverse events (RR, 1.79; 95% CI, 1.38-2.32; P <.001).
“Compared with placebo, SSRIs and SNRIs are more beneficial than placebo in children and adolescents; however, the benefit is small and disorder specific, yielding a larger drug-placebo difference for AD than for other conditions. Response to placebo is large, especially in DD,” study authors concluded. “Severe adverse events are significantly more common with SSRIs and SNRIs than placebo.”
Lead author Cosima Locher, PhD, of the University of Basel’s Faculty of Psychology, suggested, “With this in mind, it’s important to examine the relationship between clinical benefit and possible side effects in consultation with the doctor treating the patient.”
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