The treatment of depression in children and youths is a major health problem. Non-pharmacological interventions, such as cognitive behavioral therapy, have been shown to be effective in improving the symptoms in children and adolescents suffering from mild or moderate depressive disorders. For severe or resistant depression, pharmacological treatment may be needed. Due to the poor efficacy of tricyclic drugs and their significant adverse effects, selective serotonin reuptake inhibitors are frequently used even though their risk-benefit profile has not been clearly demonstrated in this population. Evidence from several sources suggests that in adults selective serotonin norepinephrine reuptake inhibitors (SNRIs) – such as venlafaxine, duloxetine, desvenlafaxine, and milnacipran – may be more effective treatments for depression than therapies that act on a single neurotransmitter. A recent study evaluated the efficacy and safety of SNRIs in children (7–11 years) and adolescents (12–18 years) with major depressive disorder (MDD). Five trials (three with duloxetine and two with venlafaxine), comprising 973 patients were found suitable to include in the meta-analysis. (No studies in young patients were found with milnacipran). In these trials, 60% of SNRIs-treated subjects and 55% placebo-treated subjects responded. The pooled odds ratio (OR) was 1.09 (95%CI=0.97–1.22, z=1.49, P=0.14), indicating similar efficacy between SNRIs and placebo. Only three studies, all using duloxetine, measured remission rates. 42% of SNRI-treated and 31% placebo-treated subjects remitted. The pooled OR was 1.45 (95%CI=1.01–2.09, z=2.02, P=0.04), suggesting a greater efficacy on duloxetine compared to placebo. There was, however, significant heterogeneity in effect size. Significantly more patients on SNRI therapy dropped out for adverse effects than those
on placebo (8.8 vs 3.0%; RR=2.92, 95%CI=1.67–5.09, P=0.0002). The authors conclude that SNRI therapy does not display superior efficacy and is less well tolerated compared to placebo in these young patients. However, duloxetine may have a beneficial effect in depressed children and adolescents which needs to be investigated further.
Xu Y, Bai SJ, Lan XH, Qin B, Huang T, Xie P. Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability. raz J Med Biol Res. 2016;49. pii: S0100-879X2016000600704. doi: 10.1590/1414-431X20164806.
Updated December 2016