A new meta-analysis indicates that the benefits of antidepressants appear to outweigh risks for children and adolescents with depression or anxiety disorders, suggesting that increased risk for suicidal thoughts and attempts is not statistically significant, according to an article in the April 18 issue of the Journal of the American Medical Association.

Previous research has indicated that usage of antidepressants among children and adolescents is associated with an increased risk for suicidal behavior and thoughts, and resulted in the issuing of mandated label warnings on pediatric antidepressant medications by the US government’s Food and Drug Administration, according to information in the article.

Jeffrey A. Bridge, PhD, of The Ohio State University, Columbus, and colleagues conducted a review and meta-analysis of randomized controlled trials involving pediatric usage of antidepressants for major depressive disorder, obsessive-compulsive disorder, and non-obsessive compulsive disorder-related anxiety disorders.

The current analysis included recent trials that had not been incorporated into previous analyses to assess benefits and risk of suicidal thoughts and attempts. The researchers conducted a search for studies through 2006 and identified and included 27 pediatric trials for their analysis: 15 involved major depression, 6 involved obsessive-compulsive disorder, and 6 involved non-obsessive compulsive disorder-related anxiety disorders.

The researchers found: "Consistent with the analyses of the FDA, we found evidence of an overall small but increased risk of treatment-emergent suicidal ideation/suicide attempt. However, the pooled random-effects risk differences of suicidal ideation/suicide attempt for each indication were all less than 1 percent. There were no completed suicides in these trials."

"This meta-analysis of all available randomized clinical trials of antidepressant treatment of pediatric major depression, obsessive-compulsive disorder, and non-obsessive compulsive disorder anxiety disorders shows evidence of efficacy for all three indications, although the effects were strongest for anxiety disorders, intermediate for obsessive compulsive disorder, and more modest in major depression," the authors wrote.

Adolescents appeared to respond better than children to antidepressants in trials of both depression and anxiety.

"Some may argue that any risk of suicidal ideation/suicide attempt cannot possibly justify treatment with antidepressants for children and adolescents. Instead, we believe that the strength of evidence presented here supports the cautious and well-monitored use of antidepressant medications as one of the first-line treatment options, with the recognition that efficacy appears greatest for non-obsessive compulsive disorder anxiety disorders, intermediate for obsessive compulsive disorder, and more modest for major depressive disorder. Since the choice of treatment should be the result of a collaborative discussion between clinician, family, and patient, the information presented in this report should allow for an informed evaluation of the potential benefits and risks of these medications vs. no treatment and provide a framework for their comparison with nondrug treatments as well," the researchers concluded.