Meta studies: Antidepressants hardly any better than placebo in children

Placebo effect and antidepressants in children and adolescents: antidepressants hardly any better
Children suffer above all from anxiety disorders, depressive moods, obsessive-compulsive disorders or post-traumatic stress disorders. The clinical efficacy of antidepressants in children and adolescents has been proven, but it is prescribed with caution in practice because the side effects are great. In addition, the placebo effect on the effect of the drugs is unclear. Researchers at the University of Basel have now investigated how high the effect is compared to placebos. A meta-analysis of the data from over 6,500 patients now shows that antidepressants work better than placebo, but the difference is small and varies depending on the type of mental disorder. The journal "JAMA Psychiatry" has published the results of the University of Basel and Harvard Medical School.

The most common mental disorders in children and adolescents include anxiety disorders, depressive disorders, obsessive-compulsive disorder and post-traumatic stress disorder. In addition to psychotherapeutic interventions, children and adolescents are also given newer antidepressants for treatment, such as selective serotonin reuptake inhibitors (SSRI) and serotonin noradrenaline reuptake inhibitors (SNRI).

Antidepressants work better than placebo, but have more side effects
Psychologists from the University of Basel, together with colleagues from Harvard Medical School and the American National Institute of Mental Health, analyzed 36 drug studies. The studies included a total of 6778 children and adolescents up to 18 years of age.

The results of the meta-analysis show on the one hand that antidepressants have a significantly better effect on the various disorders compared to placebo, but the difference is small and varies depending on the type of mental disorder. On the other hand, it was shown that the placebo effect plays an essential role in the effects of antidepressants. The study also found that patients treated with antidepressants complained of more side effects than those who received a placebo. The side effects ranged from mild symptoms such as headaches to suicidal acts.

Placebo effect stronger for depression
According to the study, the effects of antidepressants and placebo differ depending on the type of mental disorder: antidepressants have a greater specific effect in anxiety disorders than in depressive disorders. In contrast, placebos are more effective in depressed patients than in those with an anxiety disorder. The first authors Dr. Cosima Locher and Helen Koechlin from the Department of Clinical Psychology and Psychotherapy from the Faculty of Psychology at the University of Basel see potential for new treatment concepts that take advantage of the effects of the factors that contribute to the placebo effect in depression.

Individual clarification necessary
The meta-analysis also shows that antidepressants play an important role in the treatment of mental disorders in children and adolescents. "It is important to clarify the relationship between clinical benefit and possible side effects in an interview with the doctor treating you," says Locher.

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