PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of bmjLink to Publisher's site
 
BMJ. 1995 April 8; 310(6984): 897–901.
PMCID: PMC2549288

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.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Ambrosini PJ, Bianchi MD, Rabinovich H, Elia J. Antidepressant treatments in children and adolescents. I. Affective disorders. J Am Acad Child Adolesc Psychiatry. 1993 Jan;32(1):1–6. [PubMed]
  • Ambrosini PJ, Bianchi MD, Rabinovich H, Elia J. Antidepressant treatments in children and adolescents: II. Anxiety, physical, and behavioral disorders. J Am Acad Child Adolesc Psychiatry. 1993 May;32(3):483–493. [PubMed]
  • Campbell M, Spencer EK. Psychopharmacology in child and adolescent psychiatry: a review of the past five years. J Am Acad Child Adolesc Psychiatry. 1988 May;27(3):269–279. [PubMed]
  • Riddle MA, Nelson JC, Kleinman CS, Rasmusson A, Leckman JF, King RA, Cohen DJ. Sudden death in children receiving Norpramin: a review of three reported cases and commentary. J Am Acad Child Adolesc Psychiatry. 1991 Jan;30(1):104–108. [PubMed]
  • Riddle MA, Geller B, Ryan N. Another sudden death in a child treated with desipramine. J Am Acad Child Adolesc Psychiatry. 1993 Jul;32(4):792–797. [PubMed]
  • Geller B, Fox LW, Fletcher M. Effect of tricyclic antidepressants on switching to mania and on the onset of bipolarity in depressed 6- to 12-year-olds. J Am Acad Child Adolesc Psychiatry. 1993 Jan;32(1):43–50. [PubMed]
  • Akiskal HS, Mallya G. Criteria for the "soft" bipolar spectrum: treatment implications. Psychopharmacol Bull. 1987;23(1):68–73. [PubMed]
  • Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC. Meta-analyses of randomized controlled trials. N Engl J Med. 1987 Feb 19;316(8):450–455. [PubMed]
  • Chalmers TC, Smith H, Jr, Blackburn B, Silverman B, Schroeder B, Reitman D, Ambroz A. A method for assessing the quality of a randomized control trial. Control Clin Trials. 1981 May;2(1):31–49. [PubMed]
  • Petti TA. Scales of potential use in the psychopharmacologic treatment of depressed children and adolescents. Psychopharmacol Bull. 1985;21(4):951–977. [PubMed]
  • Puig-Antich J, Perel JM, Lupatkin W, Chambers WJ, Tabrizi MA, King J, Goetz R, Davies M, Stiller RL. Imipramine in prepubertal major depressive disorders. Arch Gen Psychiatry. 1987 Jan;44(1):81–89. [PubMed]
  • Kramer AD, Feiguine RJ. Clinical effects of amitriptyline in adolescent depression. A pilot study. J Am Acad Child Psychiatry. 1981 Summer;20(3):636–644. [PubMed]
  • Petti TA, Law W., 3rd Imipramine treatment of depressed children: a double-blind pilot study. J Clin Psychopharmacol. 1982 Apr;2(2):107–110. [PubMed]
  • DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep;7(3):177–188. [PubMed]
  • Berney T, Kolvin I, Bhate SR, Garside RF, Jeans J, Kay B, Scarth L. School phobia: a therapeutic trial with clomipramine and short-term outcome. Br J Psychiatry. 1981 Feb;138:110–118. [PubMed]
  • Kashani JH, Shekim WO, Reid JC. Amitriptyline in children with major depressive disorder: a double-blind crossover pilot study. J Am Acad Child Psychiatry. 1984 May;23(3):348–351. [PubMed]
  • Preskorn SH, Weller EB, Weller RA. Depression in children: relationship between plasma imipramine levels and response. J Clin Psychiatry. 1982 Nov;43(11):450–453. [PubMed]
  • Geller B, Cooper TB, McCombs HG, Graham D, Wells J. Double-blind, placebo-controlled study of nortriptyline in depressed children using a "fixed plasma level" design. Psychopharmacol Bull. 1989;25(1):101–108. [PubMed]
  • Geller B, Cooper TB, Graham DL, Fetner HH, Marsteller FA, Wells JM. Pharmacokinetically designed double-blind placebo-controlled study of nortriptyline in 6- to 12-year-olds with major depressive disorder. J Am Acad Child Adolesc Psychiatry. 1992 Jan;31(1):34–44. [PubMed]
  • Bernstein GA, Garfinkel BD, Borchardt CM. Comparative studies of pharmacotherapy for school refusal. J Am Acad Child Adolesc Psychiatry. 1990 Sep;29(5):773–781. [PubMed]
  • Geller B, Cooper TB, Graham DL, Marsteller FA, Bryant DM. Double-blind placebo-controlled study of nortriptyline in depressed adolescents using a "fixed plasma level" design. Psychopharmacol Bull. 1990;26(1):85–90. [PubMed]
  • Hughes CW, Preskorn SH, Weller E, Weller R, Hassanein R, Tucker S. The effect of concomitant disorders in childhood depression on predicting treatment response. Psychopharmacol Bull. 1990;26(2):235–238. [PubMed]
  • Boulos C, Kutcher S, Marton P, Simeon J, Ferguson B, Roberts N. Response to desipramine treatment in adolescent major depression. Psychopharmacol Bull. 1991;27(1):59–65. [PubMed]
  • Byrne MM. Meta-analysis of early phase II studies with paroxetine in hospitalized depressed patients. Acta Psychiatr Scand Suppl. 1989;350:138–139. [PubMed]
  • Sheldon Trevor A, Mason James, Song Fujian, Freemantle Nick, House Alan. Effective and acceptable treatment for depression: Authors' reply. BMJ. 1993 Apr 24;306(6885):d1126–1127. [PMC free article]
  • Fisher S, Greenberg RP. How sound is the double-blind design for evaluating psychotropic drugs? J Nerv Ment Dis. 1993 Jun;181(6):345–350. [PubMed]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Group