Meta-Analysis of Psychopharmacologic Treatment of Child and Adolescent Depression: Deconstructing Previous Reviews, Moving Forward

Abstract

The proliferation of Selective Serotonin Reuptake Inhibitors (SSRIs) in the 1980s led to increased use of an-tidepressant medications for children and adolescents with Major Depressive Disorder (MDD). Since then, there have been 18 reviews of this literature with nine being meta-analytic. Many of these meta-analyses suffer from several methodological problems: did not statistically compare medication efficacy, included only randomized placebo control trials, calculated response rate rather than risk-difference and odds ratio, were conducted prior to the 2009 publication of the PRISMA meta-analyses standards, rarely addressed publication bias, and failed to conduct meta-regressions to account for moderator variables. The purpose of the present meta-analysis was to address each of these limitations. Results indicated SSRIs were the most effective class of medication with Sertraline having the highest response rate and Citalopram having the lowest response rate. Overall, Nefazodone had the highest response rate of any medication regardless of class, although there was a relatively small sample size (n = 39). When examining publication bias, only SSRIs had statistically significant positive findings. In terms of moderator variables, RCTs and open-label trials predicted response rate, as did age and gender (females).