The Issue:  Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of drugs used to treat depression, anxiety, obsessive-compulsive disorder, and other psychiatric disorders.  Published data show these medications to be effective, but the tests have mostly been done with adults. Because there is so little published data on the use of SSRIs in children, the authors of this review decided to include findings from un-published studies. They wanted to see if the combined  evidence would warrant changes in the way doctors prescribe these medications to children.

The Research: The authors reviewed studies of children aged 5 to 18 years who were prescribed an SSRI after being diagnosed with depression.  Both published and unpublished studies were considered.  The antidepressant drugs studied were fluoxetine (Prozac™), paroxetine (Paxil™), sertraline (Zoloft™), citalopram (Celexa™), and venlafaxine (Effexor™).

The Results: The review found that only fluoxetine (Prozac™) has good evidence that it is safe and effective in the treatment of child and adolescent depression.  Published and unpublished studies on paroxetine taken together showed that patients had little or no relief of symptoms and had an increased risk of a serious side effect, including suicidal thinking or attempting suicide.  Sertaline was found to be ineffective when both published and unpublished data were analyzed together, and there was an increase in suicidal thinking and suicide attempts. Studies of citalopram and venlaxafine had essentially the same findings, with venlaxafine also having a high rate of side effects and an increased risk of suicidal behaviour.

The reviewers found that the inclusion of information contained in unpublished data on trials of antidepressant use in children and adolescents would change practice because they showed the drugs, with the exception of fluoxetine, were neither safe nor effective for this patient population.

+++

The preceding is a summary of: Whittington CJ, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Boddington E.
Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. The Lancet 2004, 363: 1341-1345.

Attachments:

File	File size	Last Modified
SSRIs as treatment.pdf	84 Kb	05/03/10 13:46