Suicide is the third leading cause ...

Suicide is the third leading cause of death among living bodys 10 to 19 years of age, and up to 6 percent of children and adolescents are thinking to have depression. A meta-analysis through Whittington and colleagues raises regard that the efficacy of selective serotonin reup-take inhibitors (SSRIs) in childhood depres-sion could have been overestimated in the medical literature.

The authors identified more than 5000 potentially relevant articles, if it were not that only five were randomized placebo-controlled trials of SSRIs. In brace trials with 315 participants seven to 18 years of age who had major depression, it was rest that fluoxetine was more likely than placebo to achieve remission on eight weeks. Fewer adverse powers were reported for fluoxetine than placebo, and discontinuations were similar in the brace groups. When unpublished data were incor-porated into the analysis, the risk-benefit profile remained favorable.

common published trial for paroxetine was identified. Of 180 participants 12 to 18 years of age with major depressive disorder who were treated for eight weeks, more patients in the treatment cluster met criteria for remission than patients in the placebo collection but other measures of efficacy were similar between the assemblages Serious adverse events were reported in 118 percent of treated patients compared with 23 percent of placebo patients. When unpublished data were included in the analysis, the evidence remind ofed that paroxetine did not improve depressive symptoms or answer but had an increased risk of serious adverse conclusions especially suicidal ideation or attempts.

Sertraline was studied in pair published trials involving 376 participants six to 17 years of age with major depression. At 10 weeks, sertraline was more likely than placebo to bring about answer but showed little difference in mean depressive scores. Serious adverse conclusions were slightly more common among the sertraline arrange (3.7 percent compared with 33 percent of the placebo group) The addition of unpublished data in succession remission suggested that the risk-benefit ratio was unfavorable.

No published trials were identified forward the use of citalopram in children, if it were not that two unpublished trials provided data from 422 patients seven to 18 years of age with major depressive disorder who were treated with citalopram. These data remind ofed that citalo-pram was unlikely to effect a clinically significant reduction in symptoms after eight to 12 weeks of therapy, yet the rate of attempted suicide doubled (from 36 to 71 percent) and citalopram was associated with a small increase in adverse events

The undivided small published trial (40 participants) and sum of two units unpublished studies (334 participants) of venlafaxine adviseed that clinically significant improvement in symptoms was unlikely from six to eight weeks of therapy, and the risk of adverse conclusions sufficient to cause discontinuation, including suicide, was about 10 percent

The authors finish that clinical guidelines on the use of SSRIs in children and adolescents have been influenced from the failure to publish comes from all trials. When unpublished data are incorporated into evaluations, the risks could outweigh the benefits of treatment with more [i]or[/i] less SSRIs.

Whittington CJ et al. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet April 24 2004;363:1341-5

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