安慰剂
荟萃分析
重性抑郁障碍
抗抑郁药
严格标准化平均差
评定量表
萧条(经济学)
医学
精神科
人口
内科学
随机对照试验
临床心理学
心理学
焦虑
心情
替代医学
发展心理学
宏观经济学
病理
经济
环境卫生
作者
Anna Feeney,Rebecca S. Hock,Maurizio Fava,Jesús M. Hernández Ortiz,Nadia Iovieno,George I. Papakostas
标识
DOI:10.1016/j.jad.2022.02.074
摘要
There are few available antidepressants for pediatric Major Depressive Disorder (MDD). The objective of this systematic review and meta-analysis was to review industry-funded studies of antidepressants in children and adolescents with MDD, and to better understand the contribution of study design and placebo response to the findings of these studies.Randomized, double-blind, placebo-controlled clinical trials that compared antidepressant with placebo for the acute treatment of MDD in children and/or adolescents were selected. Estimates of the standardized mean difference (SMD) in change in Children's Depression Rating Scale-Revised scores were pooled, after examining for heterogeneity. A random-effects meta-analysis was completed.Thirty-four antidepressant-placebo comparisons, involving 6161 subjects, were included. The SMD among all studies was 0.12 (CI 0.08, 0.17; p < 0.001), a very small effect size, lower than that seen in studies of adults with MDD. When the meta-analysis was limited to studies with a low mean placebo response, the SMD increased to 0.19 and further increased to 0.22 when studies with at least a 50% chance of receiving placebo were included.Many studies focused on older children and younger adolescents. Our findings may not reflect antidepressant efficacy in older adolescents.The modest SMD identified in this analysis may reflect study design factors and the application of antidepressants developed for adults to pediatric patients. Given the urgent clinical need for more pediatric MDD treatments, the influence of placebo response and the need for drug development tailored to this population should be considered in pediatric MDD trial design.
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