In a large review study published this week in The Lancet, researchers assessed the effectiveness and potential harms of fourteen different antidepressants for their use in children and adolescents. The negative results, familiar to MIA readers, are now making major headlines.
“There is little reason to think that any antidepressant is better than nothing for young people,” Mad In America (MIA) contributor Jon Jureidini wrote in an official commentary on the study.
The researchers, led by Andrea Cipriani, of the University of Oxford in the United Kingdom, conducted a systematic meta-analysis of both published and unpublished randomized control trials on the use of antidepressants for the treatment of ‘major depression’ in children and young adults. They examined trials on fourteen different antidepressants: amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine.
The study also used the Cochrane risk of bias measures to account for the quality of the included studies. The bias analysis was essential to their conclusions as 88% of all of the trials were found to have a risk for bias (29% high risk, 59% moderate risk) and 65% of all of the trials were funded by drug companies.
After examining 34 trials on over 5 thousand participants, the researchers concluded that antidepressants did not offer a clear benefit or advantage to children and adolescents beyond placebo and, further, that they can be potentially harmful. While the data was found to be biased and inadequate to assess the risk of suicide accurately, the study did conclude that venlafaxine appeared to carry the greatest danger for suicide and suicidal thoughts.
Overall, the quality of the existing trials on the effectiveness of antidepressants was rated very low. In an accompanying editorial, MIA contributor Jon Jureidini pushed for more transparency and open access to data from psychiatric drug trials.
“We doctors and researchers are failing to meet our obligation to research participants and to our patients, and we will only succeed if independent researchers such as Cipriani and colleagues are able to analyze individual patient-level data,” he wrote.
“Claims that appropriate access to such data is incompatible with intellectual property constraints and patient privacy must be strongly resisted.”
For a full description of the history of the marketing of SSRI antidepressants to children and adolescents, see Whitaker and Cosgrove’s Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. Their work (pgs 102-107, 129-133) details the financial conflicts of interests that incentivize the use of SSRIs in children and takes a closer look at how previous studies were misrepresented in order to increase sales.
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The Washington Post: For young people with major depression, antidepressants may help little if at all
CBS News: Most antidepressants ineffective in teens, study finds
Psychiatry Advisor: Meta-Analysis Indicates Antidepressants Ineffective in Children, Teens
NBC News: Most Antidepressants Don’t Work for Kids, Study Finds
The Guardian: Most antidepressants not working for children and teenagers – study
ABC News: Antidepressants for kids and teens ineffective, may even be harmful, study finds
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Cipriani, A., et al. “Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis.” The Lancet. (Abstract)
Jureidini, J. “Antidepressants fail, but no cause for therapeutic gloom.” The Lancet. (Abstract)
Glad they are publishing this, but it should not be news. There has never been any real data supporting effectiveness of antidepressants in youth and especially in children. The younger you are, the more useless they appear to be. Maybe it’s because the placebo effect doesn’t work as well on kids, since it looks like 80% or more of the AD’s actions are placebo effect.
— Steve
And they don’t do such a bang up job for adults either!
And what will change?
I notice that the Washington Post article, right out of the gate, says that antidepressants “have been proven to be effective for most adults.” Even the drug companies wouldn’t make that ludicrous a claim. Do newspapers not even have editors anymore?
Apparently I live in a world full of people who think pills know how old the person taking them is, how bizarre. The antidepressants are ineffective and / or harmful to many adults, too. But despite the misinformation in the articles, and seeming Pharma worship in a couple of the articles, it’s at least good this is making the mainstream “news.” Although I agree with Steve, it should not be considered “news.” But maybe, hopefully, this might someday soon help curb the massive drugging of children in the US.
How many of these articles have to be published before doubt makes a dent in the public’s quasi-religious belief system in these drugs (and in the MDs who deliver them)? The power of that whole narrative over the public imagination is nothing less than spectacular.
Liz Sydney
Research has never had much impact on religious mythology. People WANT to believe that narrative, because it lets adults and people in power off the hook for their oppressive behavior. It’s not how we treat them, it’s their BRAINS that are at fault, so I don’t have to do anything about boring, authoritarian classrooms, child abuse, or racism, because if their brains worked properly, they wouldn’t MIND being mistreated!
Not to mention the profit motive… as Upton Sinclair said, “It’s difficult to get a man to understand something when his salary depends on his not understanding it.”
— Steve
This is the way the pharmacaust ends, not with a bang but a whimper.
It would be great to see the psychiatric pharmaceutical industry go on trial for crimes against humanity, bang your all busted, but the practice of drugging kids is just going to fade away with maybe a small whimper if it ever does stop completely.
Decades of child drugging on a massive scale and when it does finally end there will be no apologies and no people or institutions held accountable…
Kind of a bummer but what ever at least it will be over.
This is great news. I guess they’ll officially stop prescribing this shit to kids at the beginning of the business week, right?
How might Cipriani et al have reported this if also closely considering “Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports” BMJ 2016 Sharma et al http://www.bmj.com/content/352/bmj.i65 , and “Suicidal risk from TADS study was higher than it first appeared” Högberg et al, 2015 – http://content.iospress.com/articles/international-journal-of-risk-and-safety-in-medicine/jrs0645 both appearing after their data cut-off point.
These clearly misreported data would, i suspect have tipped the balance clearly against SSRI/SNRI medications (overall simply very poor classes of chemicals the data consistently states) including fluoxetine.
Further, if adverse effects properly considered: eg “Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants” http://www.psy-journal.com/article/S0165-1781(14)00083-3/abstract eg “Sexual Difficulties (62%) and Feeling Emotionally Numb (60%). Percentages for other effects included: Feeling Not Like Myself – 52%, Reduction In Positive Feelings – 42%, Caring Less About Others – 39%, Suicidality – 39% and Withdrawal Effects – 55%” – weighed against minimal, if ANY short term gain – is this an intervention we ought seriously be considering?
Jureidini critically emphasises this is NOT in any way saying “don’t treat” – simply don’t treat ineffectively (i.e. with these medications), with unacceptable risks, and intolerable adverse effects short, medium and longer term. Please show us the solid, verifiable, openly accessible patient level data, not “expert opinion”, which shows otherwise.