Most available antidepressants do not help children and teenagers with serious mental health problems and some may be unsafe, experts have warned.
A review of clinical trial evidence found that of 14 antidepressant drugs only one, fluoxetine – marketed as Prozac – was better than a “dummy” placebo at relieving the symptoms of young people with major depression.
The researchers conducted a systematic review of all published and unpublished trials looking at the effects of 14 antidepressants in young people with major depression up to the end of May 2015.
Analysis of 34 trials involving 5,260 participants aged nine to 18 found that only in the case of fluoxetine did benefits outweigh risks in terms of efficacy and tolerability.
Nortriptyline was less effective than seven other drugs and placebo, while imipramine, venlafaxine and duloxetine were the least well tolerated.
Compared with placebo and five other drugs, venlafaxine was linked to an increased risk of suicidal attempts or thoughts.
But the authors, writing in The Lancet medical journal, stressed that the true effectiveness, safety and “suicidility risk” of antidepressants taken by children and teenagers remained unclear because of a lack of reliable data.
Pharmaceutical companies funded 65% of the trials and 10 were judged to have shown a high risk of bias. The overall quality of evidence for primary outcomes was “very low”, the researchers concluded.
They recommended close monitoring of young people on antidepressants, regardless of what drugs they were prescribed, especially at the start of treatment.
Major depressive disorder affects around 3% of children aged six to 12 and 6% of teenagers aged 13 to 18.
In 2004 the US Food and Drug Administration issued a warning against the use of antidepressants in young people up to the age of 24 because of concerns about suicide risk – yet the number of young people taking the drugs increased between 2005 and 2012.
In the UK, the proportion of children and teenagers aged 19 and under taking antidepressants rose from 0.7% to 1.1%.