Abstract: Significant controversy surrounds the efficacy of the newer antidepressants for children and adolescents with depression. The controversy largely hinges on meta-analyses of studies that suggest that antidepressants are minimally effective, not effective, or equivalent to placebo. In this review, the author discusses several scientific and clinical complexities that are important to understand in reviewing the antidepressant literature: the strengths and weaknesses of meta-analyses; the scientific and regulatory context for the large number of antidepressant trials in the late 1990s and early 2000s; and the distinction between a negative trial, where the treatment does not demonstrate efficacy, and a failed trial, where methodological problems make it impossible to draw any conclusion about efficacy. It is the premise of this review that meta-analyses that include the large number of industry-sponsored antidepressant trials distort the picture of antidepressant efficacy for teen depression. Industry-sponsored child and adolescent depression trials suffer from a number of implementation challenges and should be considered failed trials that are largely uninformative and not eligible to be included in efficacy meta-analyses. In contrast to the industry-sponsored trials, depression trials funded by the National Institute of Mental Health (NIMH) (N=2) are characterized by many methodological strengths, lower placebo response rates (30%−35%), and meaningful between-group differences (25%−30%) that support antidepressant efficacy. The NIMH-funded trials, taken together with the demonstrated efficacy of the serotonin reuptake inhibitors for childhood-onset obsessive-compulsive disorder and the anxiety disorders, suggest a broad and important role for antidepressant medications in pediatric internalizing conditions.
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The participant will analyze the scientific and clinical complexities inherent in understanding literature on the effectiveness of newer antidepressant medications for children and adolescents with depression.
This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.
Estimated Time to Complete
Duration: 1 hour
Begin Date: May 1, 2017
End Date: April 30, 2019
How to Earn Credit
In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™). A score of 60% or higher is required to receive credit.
Continuing Education Credit
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
Title: Antidepressant Efficacy for Depression in Children and Adolescents: Industry- and NIMH-Funded Studies
Authors: John T. Walkup, M.D.
Affiliations: From the Department of Psychiatry, Weill Cornell Medicine and New York–Presbyterian, New York (J.T.W.).
Disclosures: Dr. Walkup has received research grant support from the Hartwell Foundation and the Tourette Association of America and royalties from Guilford Press, Oxford University Press, Wolters Kluwer, and Medical Information Systems; he has received honoraria for presentations at the American Academy of Child and Adolescent Psychiatry, American Psychiatric Association annual meetings, the Tourette Association of American (funded by a grant from the Centers for Disease Control and Prevention), and the Nevada Psychiatric Association; he serves in an unpaid capacity on advisory boards for the American Foundation of Suicide Prevention, the TLC Foundation for Body-Focused Repetitive Behaviors, and the Anxiety and Depression Association of America. Previously, Dr. Walkup was an investigator in the Treatment for Adolescents With Depression Study, the Treatment of Adolescent Suicide Attempters study, and studies conducted by the Sertraline Pediatric Depression Study Group; he was also involved in a number of NIMH-funded and industry-funded studies of obsessive-compulsive disorder (OCD), the non-OCD anxiety disorders, bipolar disorder, and attention deficit hyperactivity disorder between 1997 and 2009.
Discussion of unapproved or investigational use of products*: No.
*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.
Robert Freedman, M.D. (Editor-in-Chief, AJP); Susan K. Schultz, M.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals).
Dr. Schultz has received research support from the Alzheimer’s Disease Cooperative Study for projects conducted in partnership with Toyama Chemical Company and in partnership with Eli Lilly and Company. Dr. Freedman, Mr. Roy, and Mr. Pogachar report no financial relationships with commercial interests.
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