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Review: Benefits of antidepressants outweigh risks of suicidal ideation and attempts in children and adolescents

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How effective are antidepressants for paediatric major depressive disorder, obsessive compulsive disorder (OCD) and non-OCD anxiety disorders, and do they increase suicidal ideation or suicide attempts?

Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment - a meta-analysis of randomized controlled trials. JAMA 2007;297:1683–96.

METHODS

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Systematic review with meta-analysis.

Embedded ImageData sources:

PubMed (January 1988 to July 2006); abstracts of scientific meetings; FDA and MHRA reports; reference lists of articles; clinical trial registries; and contact with authors.

Embedded ImageStudy selection and analysis:

Randomised controlled trials (RCTs) comparing second generation antidepressants versus placebo, in children and adolescents (aged <19 years) with major depressive disorder (MDD), OCD or non-OCD anxiety disorders. Data on suicide outcomes were obtained from an FDA review of antidepressants and paediatric suicidal behaviour, study reports and from investigators. Exclusions were: studies of tricyclic antidepressants or monoamine oxidase inhibitors; crossover RCTs; studies in treatment responders only; studies still recruiting patients; use of cognitive behavioural therapy; inability to obtain data from author; or studies of anxiety-related …

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