Efficacy of tricyclic drugs in treating child and adolescent depression: a meta-analysis

Abstract Objective : To examine whether tricyclic antidepressants are superior to placebo in the treatment of child and adolescent depression. Design : Meta-analysis of 12 randomised controlled trials comparing the efficacy of tricyclic antidepressants with placebo in depressed subjects aged 6-18 years. Main outcome measures : Most studies employed several depression rating scales. For each study the “best available” measure was chosen by using objective criteria, and individual and pooled effect sizes were calculated as the number of standard deviations by which the change scores for the treatment groups exceeded those for the control groups. Where authors had reported numbers “responding” to treatment we calculated individual and pooled ratios for the odds of improvement in treated compared with control subjects. Results : From the six studies presenting data which enabled an estimation of effect size the pooled effect size was 0.35 standard deviations (95% confidence interval of -0.16 to 0.86) indicating no significant benefit of treatment. From the five studies presenting data on the number of “responders” in each group, the ratio of the odds of a response in the treated compared with the control subjects was calculated and the pooled odds ratio was 1.08 (95% confidence interval of 0.53 to 2.17); again indicating no significant benefit of treatment. The pooled sample had more than an 80% chance of detecting a treatment effect of 0.5 standard deviations or greater. There was an inverse relation between study quality and estimated treatment effect. Conclusions : Tricyclic antidepressants appear to be no more effective than placebo in the treatment of depression in children and adolescents. Key messages Key messages Previous studies, and narrative reviews of the topic, have shown that tricyclic antidepressants are of equivocal benefit in juvenile depression * This meta-analysis of 12 randomised double blind placebo controlled trials found an overall small but clinically non-significant treatment effect Tricyclic drugs are not recommended as a first line treatment for depression in children and adolescents