Antidepressants for kids may be 'hyped'
Anna Salleh
ABC Science Online (Source: News In Science) Monday, 12 April 2004
Antidepressants in children: do the risks outweigh the benefits?
Children and adolescents are being prescribed antidepressants largely on the basis of industry-funded studies that exaggerate the drugs' benefits and downplay their risks, says an Australian-led team.
Anna Salleh
ABC Science Online (Source: News In Science) Monday, 12 April 2004
Antidepressants in children: do the risks outweigh the benefits?
Children and adolescents are being prescribed antidepressants largely on the basis of industry-funded studies that exaggerate the drugs' benefits and downplay their risks, says an Australian-led team.
Dr Jon Jureidini, head of the psychological medicine department at the Women's and Children's Hospital in Adelaide, led the study, which was published in the current issue of the British Medical Journal.
"Really the risk-benefit analysis is looking very unfavourable for these drugs," Jureidini told ABC Science Online.
"GPs should not be initiating the prescription of these drugs in children and adolescents," he said. "There may be still be a role for their use in child psychiatry but I personally would be very reluctant to use them."
The team reviewed the six published randomised controlled trials comparing newer antidepressants to placebo. These drugs include selective serotonin reuptake inhibitors and venlafaxine, which the researchers reported have been increasingly used in the under-18s.
"In discussing their own data, the authors of all of the four larger studies have exaggerated the benefits, downplayed the harms, or both," they wrote.
The researchers found that despite the short follow-up period for trials and the relatively small numbers of participants, the trials still reported adverse effects.
"These were noted in the study findings but were dismissed in the study conclusions," said Jureidini
"If these drugs were shown to be really effective then you might be put aside those safety concerns," he said. "But given the fact that our analysis shows that these drugs haven't been demonstrated to be incredibly significantly effective, then why would you take the risk?"
The researchers found of the 42 outcomes measured in the studies only one-third showed that taking the drug offered a statistical advantage to the placebo.
"We are concerned that biased reporting and overconfident recommendations in treatment guidelines may mislead doctors, patients, and families," wrote Jureidini's team, which questioned whether journals had adequately scrutinised the studies before publishing the research.
According to the study, pharmaceutical companies funded the trials and otherwise remunerated the authors of at least three of the four larger studies reviewed. Funding arrangements for the other two trials were not disclosed.
Doctors' dilemmas
A spokesperson on child psychiatry for the Royal Australian and New Zealand College of Psychiatrists welcomed the study.
"I think it's an important paper," she told ABC Science Online. "It's very important that we take a critical look at the state of the evidence as regards the use of antidepressants in children and adolescent. There is insufficient evidence, of not particularly good quality, on which to make very clear decisions.
"However there still remains a dilemma for clinicians in that we do see children and young people in increasing numbers with significant depression and we know from clinical experience that some, particularly adolescents and older children, will have a very similar pattern of depression to adults and they do respond to antidepressants.
"I think the very strong point the paper makes, which we would support, is that it's very important to look at antidepressants in context: that there are many other non-pharmacological treatments for children and adolescents with depression and anxiety."
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"Really the risk-benefit analysis is looking very unfavourable for these drugs," Jureidini told ABC Science Online.
"GPs should not be initiating the prescription of these drugs in children and adolescents," he said. "There may be still be a role for their use in child psychiatry but I personally would be very reluctant to use them."
The team reviewed the six published randomised controlled trials comparing newer antidepressants to placebo. These drugs include selective serotonin reuptake inhibitors and venlafaxine, which the researchers reported have been increasingly used in the under-18s.
"In discussing their own data, the authors of all of the four larger studies have exaggerated the benefits, downplayed the harms, or both," they wrote.
The researchers found that despite the short follow-up period for trials and the relatively small numbers of participants, the trials still reported adverse effects.
"These were noted in the study findings but were dismissed in the study conclusions," said Jureidini
"If these drugs were shown to be really effective then you might be put aside those safety concerns," he said. "But given the fact that our analysis shows that these drugs haven't been demonstrated to be incredibly significantly effective, then why would you take the risk?"
The researchers found of the 42 outcomes measured in the studies only one-third showed that taking the drug offered a statistical advantage to the placebo.
"We are concerned that biased reporting and overconfident recommendations in treatment guidelines may mislead doctors, patients, and families," wrote Jureidini's team, which questioned whether journals had adequately scrutinised the studies before publishing the research.
According to the study, pharmaceutical companies funded the trials and otherwise remunerated the authors of at least three of the four larger studies reviewed. Funding arrangements for the other two trials were not disclosed.
Doctors' dilemmas
A spokesperson on child psychiatry for the Royal Australian and New Zealand College of Psychiatrists welcomed the study.
"I think it's an important paper," she told ABC Science Online. "It's very important that we take a critical look at the state of the evidence as regards the use of antidepressants in children and adolescent. There is insufficient evidence, of not particularly good quality, on which to make very clear decisions.
"However there still remains a dilemma for clinicians in that we do see children and young people in increasing numbers with significant depression and we know from clinical experience that some, particularly adolescents and older children, will have a very similar pattern of depression to adults and they do respond to antidepressants.
"I think the very strong point the paper makes, which we would support, is that it's very important to look at antidepressants in context: that there are many other non-pharmacological treatments for children and adolescents with depression and anxiety."
Related Stories
Antidepressants: possible side effects, The Health Report Radio National 29 Mar 2004
The antidepressants debate: depressed, bothered or bewildered? All in the Mind Radio National 12 Oct 2003
Medical scientists too close to industry, study shows, News in Science 24 Jan 2003
