Benefits of Antidepressants May Outweigh Risks for Kids

April 17, 2007 • Science Update

The benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders, according to a new comprehensive review of pediatric trials conducted between 1988 and 2006. The study, partially funded by NIMH, was published in the April 18, 2007, issue of the Journal of the American Medical Association.

"Although we cannot ignore the possibility that antidepressants may exacerbate suicidal thoughts and actions in some children, it would be worse to let these children go untreated," said NIMH Director Thomas R. Insel, MD. "This study indicates that more children are ultimately helped by antidepressant treatment than harmed."

In 2004, the U.S. Food and Drug Administration (FDA) required a "black box" warning on all antidepressants after a thorough review of published and unpublished data revealed a slight increase in suicidal thoughts and actions among children and adolescents taking antidepressants, compared to those taking a placebo (sugar pill). A black box warning is the FDA's most serious type of warning.

Jeffrey Bridge, PhD, of the Columbus Children's Research Institute and The Ohio State University, corresponding author Dr. David Brent, MD, of the Western Psychiatric Institute and Clinic in Pittsburgh, Pa., and colleagues examined data from 27 clinical trials involving antidepressant use among participants younger than 19 years who were being treated for major depression, obsessive-compulsive disorder (OCD), or non-OCD anxiety disorders such as generalized anxiety disorder or social phobia. Their analysis included data from more recent trials that were not included in the FDA analysis.

By pooling the data, the researchers found that antidepressants were significantly more effective than placebo in treating these disorders. Antidepressants were especially effective in treating non-OCD anxiety disorders, in which the overall pooled response rate was 69 percent for those taking antidepressants compared to 39 percent taking placebo. Among those with OCD, the pooled response rate of the young people taking antidepressants was 52 percent, compared to 32 percent of those taking placebo. Among those with depression, the pooled response rate of the young people taking antidepressants was 61 percent, compared to 50 percent of those taking placebo. Overall, there was a slight but statistically significant increase in the risk of suicidal thoughts and actions, but no suicides occurred.

"The evidence suggests that treating young people with antidepressants is worth the small risk associated with them," said Dr. Brent. "New research should focus on developing the most efficient and effective methods for monitoring these young patients, to put both doctors and parents at ease, and to match patients with the best treatments."