Which antidepressant is best option for major depressive disorder in children and adolescents

A network meta-analysis published in Lacent online on 08 June 2016 (source below). This network meta-analysis was done to identify both direct and indirect evidence from relevant trials. 

Methods: 
* Searched PubMed, the Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, LiLACS, regulatory agencies' websites, and international registers for published and unpublished, double-blind randomised controlled trials up to May 31, 2015, for the acute treatment of major depressive disorder in children and adolescents. 
* Trials included for: amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine. 
* Exclusion criteria: Trials recruiting participants with treatment-resistant depression, treatment duration of less than 4 weeks, or an overall sample size of less than ten patient. 

Results:
* Found 34 eligible trials= 5260 participants and 14 antidepressant treatments. 
* The quality of evidence was rated as very low in most comparisons. 
* For efficacy, only fluoxetine was statistically significantly more effective than placebo (standardised mean difference −0·51, 95% credible interval [CrI] −0·99 to −0·03). 
* For tolerability, fluoxetine was also better than duloxetine (odds ratio [OR] 0·31, 95% CrI 0·13 to 0·95) and imipramine (0·23, 0·04 to 0·78). 
* Patients given imipramine, venlafaxine, and duloxetine had more discontinuations due to adverse events than did those given placebo (5·49, 1·96 to 20·86; 3·19, 1·01 to 18·70; and 2·80, 1·20 to 9·42, respectively).

Interpretation provided by authors:


(1) When considering the risk–benefit profile of antidepressants in the acute treatment of major depressive disorder, antidepressants do not seem to offer a clear advantage for children and adolescents. 


(2) Fluoxetine is probably the best option to consider when a pharmacological treatment is indicated.


Source: Source: Cipriani et al., Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet Published Online: 08 June 2016.