• Login
    View Item 
    •   ORKA Home
    • Conditions, Lifestyle Factors & Interventions
    • Conditions
    • Depressive Disorders
    • View Item
    •   ORKA Home
    • Conditions, Lifestyle Factors & Interventions
    • Conditions
    • Depressive Disorders
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis

    Thumbnail
    Date
    2020-07
    Author
    Cipriani, Andrea
    Metadata
    Show full item record
    Citation
    Xinyu Zhou, Teng Teng, Yuqing Zhang, Cinzia Del Giovane, Toshi A Furukawa, John R Weisz, Xuemei Li, Pim Cuijpers, David Coghill, Yajie Xiang, Sarah E Hetrick, Stefan Leucht, Mengchang Qin, Jürgen Barth, Arun V Ravindran, Lining Yang, John Curry, Li Fan, Susan G Silva, Andrea Cipriani, Peng Xie. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. The Lancet Psychiatry Volume 7, Issue 7, July 2020, Pages 581-601
    Abstract
    Depressive disorders are common in children and adolescents. Antidepressants, psychotherapies, and their combination are often used in routine clinical practice; however, available evidence on the comparative efficacy and safety of these interventions is inconclusive. Therefore, we sought to compare and rank all available treatment interventions for the acute treatment of depressive disorders in children and adolescents. Methods We did a systematic review and network meta-analysis. We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, PsycINFO, ProQuest, CINAHL, LiLACS, international trial registries, and the websites of regulatory agencies for published and unpublished randomised controlled trials from database inception until Jan 1, 2019. We included placebo-controlled and head-to-head trials of 16 antidepressants, seven psychotherapies, and five combinations of antidepressant and psychotherapy that are used for the acute treatment of children and adolescents (≤18 years old and of both sexes) with depressive disorder diagnosed according to standard operationalised criteria. Trials recruiting participants with treatment-resistant depression, bipolar disorder, psychotic depression, treatment duration of less than 4 weeks, or an overall sample size of fewer than ten patients were excluded. We extracted data following a predefined hierarchy of outcome measures, and assessed risk of bias and certainty of evidence using validated methods. Primary outcomes were efficacy (change in depressive symptoms) and acceptability (treatment discontinuation due to any cause). We estimated summary standardised mean differences (SMDs) or odds ratios (ORs) with credible intervals (CrIs) using network meta-analysis with random effects. This study was registered with PROSPERO, number CRD42015020841. Findings From 20 366 publications, we included 71 trials (9510 participants). Depressive disorders in most studies were moderate to severe. In terms of efficacy, fluoxetine plus cognitive behavioural therapy (CBT) was more effective than CBT alone (–0·78, 95% CrI −1·55 to −0·01) and psychodynamic therapy (–1·14, −2·20 to −0·08), but not more effective than fluoxetine alone (–0·22, −0·86 to 0·42). No pharmacotherapy alone was more effective than psychotherapy alone. Only fluoxetine plus CBT and fluoxetine were significantly more effective than pill placebo or psychological controls (SMDs ranged from −1·73 to −0·51); and only interpersonal therapy was more effective than all psychological controls (–1·37 to −0·66). Nortriptyline (SMDs ranged from 1·04 to 2·22) and waiting list (SMDs ranged from 0·67 to 2·08) were less effective than most active interventions. In terms of acceptability, nefazodone and fluoxetine were associated with fewer dropouts than sertraline, imipramine, and desipramine (ORs ranged from 0·17 to 0·50); imipramine was associated with more dropouts than pill placebo, desvenlafaxine, fluoxetine plus CBT, and vilazodone (2·51 to 5·06). Most of the results were rated as “low” to “very low” in terms of confidence of evidence according to Confidence In Network Meta-Analysis. Interpretation Despite the scarcity of high-quality evidence, fluoxetine (alone or in combination with CBT) seems to be the best choice for the acute treatment of moderate-to-severe depressive disorder in children and adolescents. However, the effects of these interventions might vary between individuals, so patients, carers, and clinicians should carefully balance the risk-benefit profile of efficacy, acceptability, and suicide risk of all active interventions in young patients with depression on a case-by-case basis.
    Description
    Available with an NHS OpenAthens log in
    URI
    https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/559
    Published online at:
    https://doi.org/10.1016/S2215-0366(20)30137-1
    Collections
    • Depressive Disorders [87]

    Oxford Health copyright © 2019
    Contact Us | Send Feedback | JSPUI
    Powered by KnowledgeArc
     

     

    Browse

    All of ORKACommunities & CollectionsBy Issue DateAuthorsTitlesSubjectsContributor DisciplineThis CollectionBy Issue DateAuthorsTitlesSubjectsContributor Discipline

    My Account

    Login

    Researcher Profiles

    Researchers

    Oxford Health copyright © 2019
    Contact Us | Send Feedback | JSPUI
    Powered by KnowledgeArc