Children’s Positive Responses to Antidepressants “Minimal” After Four Weeks

Rob Wipond

Children’s positive responses to SSRI antidepressant treatments for depression are even less significant than adult responses, and drop to “minimal” after just four weeks, according to a meta-analysis published in the Journal of the American Academy of Child & Adolescent Psychiatry.

University of Vermont-led researchers conducted a meta-analysis of randomized controlled trials comparing placebo and SSRI antidepressants for major depressive disorder (MDD) in children, including 13 trials with a total of 3,004 patients.

“SSRIs were demonstrated to have a smaller benefit in pediatric compared to adult MDD,” they concluded. “Treatment gains in pediatric MDD are greatest early in treatment and are on average minimal after 4 weeks of SSRI pharmacotherapy in pediatric MDD.”

1 Boring Old Man noted that the study found there were no differences with dosage levels or different SSRIs, and commented, “In light of the findings of the much lower efficacy of these drugs in adolescents it seems ludicrous to have the same guidelines for both adults and children given its near inertness in the latter.”

Varigonda, Anjali L., Ewgeni Jakubovski, Matthew J. Taylor, Nick Freemantle, Catherine Coughlin, and Michael H. Bloch. “Systematic Review and Meta-Analysis: Early Treatment Responses of Selective Serotonin Reuptake Inhibitors in Pediatric Major Depressive Disorder.” Journal of the American Academy of Child & Adolescent Psychiatry. Accessed May 24, 2015. doi:10.1016/j.jaac.2015.05.004. (Abstract)

a study worth looking into… (1 Boring Old Man, May 27, 2015)

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  1. Rather than poking toxic drugs down children why doesn’t someone sit down and ask them what’s going on in their lives and what’s happened to them? This is a lot less destructive and might actually lead to things that are helpful for kids. We have become a drug nation.

  2. This is also not news. It is clear that the younger the child, the less effective antidepressants of any sort seem to be. My personal assumption is that this is because the main effect of antidepressants is an active placebo effect, and the younger kids are, the less likely they are to understand or buy into the “magic pill” concept. Which is interesting, since younger kids are supposedly more prone to “magical thinking” than us more mature older folks. But in this case, it seems the psychiatric providers have cornered the “magical thinking” market, and the younger kids are still enough in tune with their gut-level instincts to not buy into the deceptive worldview.

    — Steve

    • Someone of 1boringoldman’s blog suggested that less efficacy in children could be the result of children “breaking blind” less often than adults, with the result that they are subject to the placebo effect to a *greater* extent than adults. This may be because they realize less often than adults that they are being given a placebo, because they are less aware of the tip-offs–for example, the parents may be informed of potential side effects while children are left out of the loop on that.

      • …sorry I didn’t really say that right…I think it’s not that the placebo effect is greater in children, it’s just that in the study it may that children believe less often that they are on placebo, and so the placebo effect is in force more often. Does that make sense?

        • I see – sort of the inverse of what I’m saying, but comes to the same thing: they don’t really expect there to be a difference. My guess is that often, the whole thing probably seems pointless to them anyway. I think in order to have a real placebo effect, you have to be investing some hope that the “real” pill will make things better, but if the kid doesn’t even have or understand the objective, it would be hard for their personal hopes and expectations to influence the outcome one way or the other.

          — Steve

  3. I wonder if someone can clarify something for me.

    From the summary above: “positive responses to SSRI antidepressant treatments for depression … drop to “minimal” after just four weeks”

    And from the abstract: “Treatment gains in pediatric MDD are greatest early in treatment and are on average minimal after 4 weeks of SSRI pharmacotherapy in pediatric MDD.”

    Does that mean subjects initially got “better” (by whatever measure the study used) and then got worse, so that by around 4 weeks they were minimally “better” than at zero weeks; or does it mean that subjects initially got “better” and then at around 4 weeks they continued to “improve” only minimally?

    Thanks for any help. -Ken

    • I agree the language is ambiguous, but usually what they are doing is measuring the difference between the beginning of the trial and at a certain set point, or points. So what it suggests to me is that at 4 weeks, they were at best minimally “better” than at the start. It doesn’t necessarily imply there was an improvement followed by a dropoff. To gauge that, they’d have to do a symptom check at two weeks, and “antidepressants” are generally not expected to have any significant effect for at least that long in any case.

      Does that help?

      —- Steve

  4. When did it become ethical to do drug testing on small children, especially with a class of drugs already basically known to have no benefit over placebo with adults? And to also have so many adverse effects, like turning children manic, resulting in a “childhood bipolar epidemic.”

    Why are these unethical drug studies on children still occurring?

  5. Sounds like the fat lady has sung not only for “anti-psychotics”… But I guess we all know that already, the question is when do we stop pretending these drugs are medicine to treat diseases and not toxic placebos or in some cases narcotics?