SSRIs and SNRIs Could Benefit Children With Psychiatric Disorders

Children with anxiety disorders (AD), depressive disorders (DD), obsessive-compulsive disorders (OCD), and post-traumatic stress disorder (PTSD) might benefit from selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI), according to the authors of a recent meta-analysis. However, the authors found that beneficial effects were small and disorder specific, and severe adverse events were significantly more common with the drugs than with placebo.

In their analysis, the researchers examined 36 trials that included a total of 6778 participants. The mean age of participants was 12.9 years, and 51.4% were female (3484). Seventeen studies included in the analysis examined the efficacy and safety of SSRIs and SNRIs among participants with DD, 10 studies examined their efficacy and safety among participants with AD, 8 studies examined their efficacy and safety among participants with OCD, and 1 study examined their efficacy and safety among participants with PTSD.
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The researchers’ analysis indicated that SSRIs and SNRIs were more beneficial compared with placebo, but yielded relatively small effect sizes that varied significantly by disorder. AD had significantly larger between-group effect sizes compared with DD. This difference was primarily driven by placebo response due to patients with DD exhibiting larger placebo responses compared with those with AD.

Participants who received antidepressants reported significantly more treatment-emergent adverse events and severe adverse events compared with those who received placebo. Additionally, more patients who received antidepressants discontinued studies due to adverse events.

“Compared with placebo, SSRIs and SNRIs are more beneficial than placebo in children and adolescents; however, the benefit is small and disorder specific” the researchers concluded. “Owing to the higher risk for severe adverse events, a cautious and individual cost-benefit analysis is of importance.”

—Melissa Weiss

Reference:

Locher C, Koechlin H, Zion SR, et al. Efficacy and safety of selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and placebo for common psychiatric disorders among children and adolescents: a systematic review and meta-analysis [published online August 30, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.2432.