The prescription of antidepressants to children and adolescents is a controversial topic. With respect to depressive disorders, to date no single pediatric antidepressant trial found efficacy on the pre-specified primary outcome (Healy et al., 2019). However, when meta-analytically pooled across all trials, antidepressants appear to have a statistically significant albeit marginally small benefit over placebo (Locher et al., 2017). It also appears that antidepressants are more effective for anxiety disorders than for depressive disorders (Locher et al., 2017). On the other hand, the risk of suicidal events in antidepressant recipients is about twice that seen in placebo recipients, indicating that antidepressants increase the suicide risk in children and adolescents (Sharma et al., 2016). Another issue related to the risk-benefit conundrum is the influence of the pharmaceutical industry on the design, conduct and publication of pediatric antidepressant trials (Leo, 2006). Systematic biases and even research misconduct have been documented in several industry-sponsored trials, and these flaws further complicate the interpretation of published findings on the usefulness of antidepressants in children and adolescents (Jureidini et al., 2004).
The aim of this Research Topic is to provide a forum to discuss these important issues. Researchers from the field of child and adolescent psychiatry, paediatrics, clinical psychology, social work, public health, sociology, epidemiology, clinical pharmacology and toxicology, and psychopathology, may submit high-quality research. We welcome papers of all types, including original research, opinion pieces, and review articles. Submissions can address various issues related to antidepressant prescription in children and adolescents, such as examinations of population-wide prescription patterns, longitudinal epidemiologic research on treatment-emergent adverse events, randomized clinical trials and risk-benefit evaluations in clinical samples, critical evaluations of research methodology, industry support and conflicts of interests in pediatric key opinion leaders, or attitude surveys with service users, relatives, child and adolescent psychiatrists, and pediatricians. Research studies can be aimed at depressive disorders as well as anxiety disorders and other mental health conditions, such as sleep problems. We also accept critical reflections on public health issues and mental health policy related to the treatment of pediatric depression and anxiety.
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References
Healy D, Le Noury J & Jureidini J (2018). Pediatric antidepressants: Benefits and risks. Int J Risk Saf Med, 30:1-7.
Jureidini J, Doecke CJ, Mansfield PR, et al. (2004). Efficacy and safety of antidepressants for children and adolescents. BMJ, 328:879-883.
Leo J. (2006). The SSRI trials in children: disturbing implications for academic medicine. Ethical Hum Psychol Psychiatry, 8:29-41.
Locher C, Koechlin H, Zion SR, et al. (2017). 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. JAMA Psychiatry, 74:1011-1020.
Sharma T, Guski LS, Freund N & Gotzsche PC (2016). Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ, 352:i65.
The prescription of antidepressants to children and adolescents is a controversial topic. With respect to depressive disorders, to date no single pediatric antidepressant trial found efficacy on the pre-specified primary outcome (Healy et al., 2019). However, when meta-analytically pooled across all trials, antidepressants appear to have a statistically significant albeit marginally small benefit over placebo (Locher et al., 2017). It also appears that antidepressants are more effective for anxiety disorders than for depressive disorders (Locher et al., 2017). On the other hand, the risk of suicidal events in antidepressant recipients is about twice that seen in placebo recipients, indicating that antidepressants increase the suicide risk in children and adolescents (Sharma et al., 2016). Another issue related to the risk-benefit conundrum is the influence of the pharmaceutical industry on the design, conduct and publication of pediatric antidepressant trials (Leo, 2006). Systematic biases and even research misconduct have been documented in several industry-sponsored trials, and these flaws further complicate the interpretation of published findings on the usefulness of antidepressants in children and adolescents (Jureidini et al., 2004).
The aim of this Research Topic is to provide a forum to discuss these important issues. Researchers from the field of child and adolescent psychiatry, paediatrics, clinical psychology, social work, public health, sociology, epidemiology, clinical pharmacology and toxicology, and psychopathology, may submit high-quality research. We welcome papers of all types, including original research, opinion pieces, and review articles. Submissions can address various issues related to antidepressant prescription in children and adolescents, such as examinations of population-wide prescription patterns, longitudinal epidemiologic research on treatment-emergent adverse events, randomized clinical trials and risk-benefit evaluations in clinical samples, critical evaluations of research methodology, industry support and conflicts of interests in pediatric key opinion leaders, or attitude surveys with service users, relatives, child and adolescent psychiatrists, and pediatricians. Research studies can be aimed at depressive disorders as well as anxiety disorders and other mental health conditions, such as sleep problems. We also accept critical reflections on public health issues and mental health policy related to the treatment of pediatric depression and anxiety.
*****
References
Healy D, Le Noury J & Jureidini J (2018). Pediatric antidepressants: Benefits and risks. Int J Risk Saf Med, 30:1-7.
Jureidini J, Doecke CJ, Mansfield PR, et al. (2004). Efficacy and safety of antidepressants for children and adolescents. BMJ, 328:879-883.
Leo J. (2006). The SSRI trials in children: disturbing implications for academic medicine. Ethical Hum Psychol Psychiatry, 8:29-41.
Locher C, Koechlin H, Zion SR, et al. (2017). 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. JAMA Psychiatry, 74:1011-1020.
Sharma T, Guski LS, Freund N & Gotzsche PC (2016). Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ, 352:i65.
