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October 2017

Effectiveness and Safety of Antidepressants for Children and Adolescents: Implications for Clinical Practice

Author Affiliations
  • 1The Werry Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
  • 2Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
JAMA Psychiatry. 2017;74(10):985-986. doi:10.1001/jamapsychiatry.2017.2410

It is now well understood that disorders of anxiety and depression in children and adolescents are common, debilitating, and largely undetected and untreated.1 The mainstays of treatment include psychological therapy, predominantly cognitive behavioral therapy, and medication, usually antidepressants, which, despite their name, are also used for anxiety disorders and obsessive-compulsive disorder.2 In this issue of JAMA Psychiatry, Locher et al3 examine the evidence for selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine inhibitors (SNRIs) for children and adolescents with anxiety disorders, depressive disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. To date, most reviews and meta-analyses have been focused on one or other disorder. Having the information gathered together in one review is helpful, particularly as there is a high rate of comorbidity between these disorders. Based on 36 studies with 6778 participants, the authors found modest effects sizes (Hedges g) from medication, ranging from 0.56 (95% CI, 0.40-0.72) for anxiety disorders through 0.39 (95% CI, 0.25-0.54) for obsessive-compulsive disorder to 0.20 (95% CI, 0.13-0.27) for depressive disorders. There was only 1 study showing no effect in posttraumatic stress disorder. Overall, the effect size was small (g = 0.32; 95% CI, 0.25-0.40).

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