Pharmacological treatment of children and adolescents with depression

Benedetto Vitiello, Anna E. Ordóñez

Research output: Contribution to journalReview articlepeer-review


Introduction: Despite an increasing number of studies, there is debate whether antidepressants have a favorable benefit/risk balance in depressed youth. Areas covered: A systematic search identified 23 systematic reviews and meta-analyses published between 2010–2016. More than 30 controlled clinical trials were conducted in adolescents, but only a few in pre-pubertal patients. About one-third of the trials were severely statistically underpowered. Most studies failed to detect differences from placebo, but a few found fluoxetine effective. Although no suicide occurred in these studies, antidepressants increased suicidality risk (including suicidal ideation and behavior) versus placebo (OR = 2.39). Only two placebo-controlled trials with acceptable statistical power were publicly funded: both showed efficacy of fluoxetine, and one found a higher incidence of suicidality (OR = 3.7, 95% C.I. 1.00–13.7). Expert opinion: In youth, antidepressants have, on average, a small therapeutic effect. The high placebo response is exacerbated by the large number of sites in many industry-funded studies. There is evidence that fluoxetine leads to greater and faster improvement than placebo or psychotherapy in adolescents. Considering both the high response to non-specific interventions and safety concerns, antidepressants should be used cautiously in youth, and limited to patients with moderate-to-severe depression for whom psychosocial interventions are either ineffective or not feasible.

Original languageEnglish (US)
Pages (from-to)2273-2279
Number of pages7
JournalExpert opinion on pharmacotherapy
Issue number17
StatePublished - Nov 21 2016


  • Antidepressants
  • children and adolescents
  • depressive disorder
  • efficacy
  • safety

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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