I wish to highlight 2 issues regarding the article on the use of antidepressants in children and adolescents.1
First, the majority of the main measures used in the 16 studies failed to support the drug over placebo. Ten of these studies were unpublished (all of which were industry-sponsored) and, of these, only 1 study showed any significant benefit over controls. Of the 6 published studies, only 4 showed any significant benefit on main measures. On its own, this suggests a publication bias where positive studies were over 6.6 times more likely to be published than negative studies. Therefore, it is premature to conclude that these drugs are superior to placebo controls. Physicians should use great caution in making decisions based on data from published studies alone.2
Second, brief psychotherapies were not highlighted as a reasonable alternative. These treatments are non-toxic and cost-effective, and preferred by patients.3 On their own, they are more effective than wait-list or minimal treatment controls — the Treatment for Adolescents With Depression Study (TADS), cited by the authors1 is an exception.4
Given the side effects and controversies surrounding antidepressants in children, brief psychotherapies should be the first-line single treatment.4 Informed consent should include telling parents that brief psychotherapies are reasonable, safe, effective alternatives to drugs. Brief psychotherapies may improve overall coping skills and prevent relapses in children. If we lack resources to provide these treatments, parents can use this evidence to lobby government and health care providers to make sure these treatments are made available.
Footnotes
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Competing interests: None declared.
REFERENCES
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