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Dr. Bob is Robert Hsiung, MD,
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Posted by psychobot5000 on April 18, 2007, at 15:51:44
http://www.cnn.com/2007/HEALTH/conditions/04/17/antidepressants.kids.ap/index.html
This appears to be a meta-analysis of sorts, focusing on pediatric efficacy and risk of antidepressants. I think the findings are fairly interesting. As described in this article, the data apparently showed one pediatric patient per hundred (taking antidepressants) who had additional suicidal thoughts, which is apparently half what the FDA previously found.
They also found the drugs are most useful for anxiety, 'moderately' effective for OCD, and less effective but still better than placebo for depression.
____________________(beginning of article follows)Antidepressants' benefits trump risks for kids
POSTED: 4:39 p.m. EDT, April 17, 2007
Story Highlights
• Antidepressants' benefits in kids, teens outweigh small risk of suicidal thoughts
• Comprehensive analysis finds risk lower than the FDA identified in 2004
• Drugs did best on anxiety, moderately well on obsessive-compulsive disorders
• They worked less well, but were still effective in treating depression
CHICAGO, Illinois (AP) -- Authors of a new comprehensive analysis of antidepressants for children and teenagers say the benefits of treatment trump the small risk of increasing some patients' chances of having suicidal thoughts and behaviors.The risk they found is lower than the one the Food and Drug Administration identified in 2004, the year the agency warned the public about the drugs' risks in children. After the warning, U.S. youth suicides increased and some mental health experts said reluctance to try antidepressants might be the reason.
The new analysis includes data from seven studies that were not part of the previous FDA analysis, including two large pediatric depression trials that were unavailable three years ago.
Researchers analyzed data on 5,310 children and teenagers from 27 studies. They found that for every 100 kids treated with antidepressants, about one additional child experienced worsening suicidal feelings above what would have happened without drug treatment. In contrast, the FDA analysis found an added risk affecting about two in 100 patients.
There were no suicides in any of the studies. The antidepressants included Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Serzone and Remeron.
"The medications are safe and effective and should be considered as an important part of treatment," said study co-author Dr. David Brent of the University of Pittsburgh School of Medicine. "The benefits seem favorable compared to the small risk of suicidal thoughts and behavior."
Drugs best for anxiety
Antidepressants worked best when used to treat anxiety, the analysis found. They worked moderately well treating obsessive-compulsive disorders. They worked less well, but were still effective in treating depression.Adolescents responded better than children to treatment for depression and anxiety, the researchers found. They also found that only Prozac worked better than dummy pills in depressed children younger than 12.
In the studies involving depression, 61 percent of patients improved while on antidepressants. But 50 percent of depressed patients taking dummy pills also improved.
Among young patients with obsessive-compulsive disorders, 52 percent improved on antidepressants, compared to 32 percent who improved on dummy pills.
And in the studies of anxiety disorders, 69 percent improved on antidepressants and 39 percent improved on dummy pills.
Posted by Phillipa on April 18, 2007, at 19:29:07
In reply to Analysis- less suicide risk-ADs better for anxiety, posted by psychobot5000 on April 18, 2007, at 15:51:44
Not impressed by the results did they combine theraphy? But good that the suicides risk is less than reported thanks. Love Phillipa
Posted by notfred on April 18, 2007, at 19:47:44
In reply to Analysis- less suicide risk-ADs better for anxiety, posted by psychobot5000 on April 18, 2007, at 15:51:44
The study is in the current JAMA:
http://jama.ama-assn.org/cgi/content/abstract/297/15/1683
Clinical Response and Risk for Reported Suicidal Ideation and Suicide Attempts in Pediatric Antidepressant Treatment
A Meta-analysis of Randomized Controlled Trials
Jeffrey A. Bridge, PhD; Satish Iyengar, PhD; Cheryl B. Salary, MD; Rémy P. Barbe, MD; Boris Birmaher, MD; Harold Alan Pincus, MD; Lulu Ren, PhD; David A. Brent, MD
JAMA. 2007;297:1683-1696.
Context The US Food and Drug Administration (FDA) has issued warnings that use of antidepressant medications poses a small but significantly increased risk of suicidal ideation/suicide attempt for children and adolescents.
Objective To assess the efficacy and risk of reported suicidal ideation/suicide attempt of antidepressants for treatment of pediatric major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and non-OCD anxiety disorders.
Data Sources and Study Selection PubMed (1988 to July 2006), relevant US and British regulatory agency reports, published abstracts of important scientific meetings (1998-2006), clinical trial registries, and information from authors. Studies were published and unpublished randomized, placebo-controlled, parallel-group trials of second-generation antidepressants (selective serotonin reuptake inhibitors, nefazodone, venlafaxine, and mirtazapine) in participants younger than 19 years with MDD, OCD, or non-OCD anxiety disorders.
Data Extraction Information was extracted on study characteristics, efficacy outcomes, and spontaneously reported suicidal ideation/suicide attempt.
Data Synthesis Twenty-seven trials of pediatric MDD (n = 15), OCD (n = 6), and non-OCD anxiety disorders (n = 6) were selected, and risk differences for response and for suicidal ideation/suicide attempt estimated by random-effects methods. Pooled risk differences in rates of primary study-defined measures of responder status significantly favored antidepressants for MDD (11.0%; [95% confidence interval {CI}, 7.1% to 14.9%]), OCD (19.8% [95% CI, 13.0% to 26.6%), and non-OCD anxiety disorders (37.1% [22.5% to 51.7%]), corresponding to a number needed to treat (NNT) of 10 (95% CI, 7 to 15), 6 (4 to 8), and 3 (2 to 5), respectively. While there was increased risk difference of suicidal ideation/suicide attempt across all trials and indications for drug vs placebo (0.7%; 95% CI, 0.1% to 1.3%) (number needed to harm, 143 [95% CI, 77 to 1000]), the pooled risk differences within each indication were not statistically significant: 0.9% (95% CI, –0.1% to 1.9%) for MDD, 0.5% (–1.2% to 2.2%) for OCD, and 0.7% (–0.4% to 1.8%) for non-OCD anxiety disorders. There were no completed suicides. Age-stratified analyses showed that for children younger than 12 years with MDD, only fluoxetine showed benefit over placebo. In MDD trials, efficacy was moderated by age, duration of depression, and number of sites in the treatment trial.
Conclusions Relative to placebo, antidepressants are efficacious for pediatric MDD, OCD, and non-OCD anxiety disorders, although the effects are strongest in non-OCD anxiety disorders, intermediate in OCD, and more modest in MDD. Benefits of antidepressants appear to be much greater than risks from suicidal ideation/suicide attempt across indications, although comparison of benefit to risk varies as a function of indication, age, chronicity, and study conditions.
Author Affiliations: Department of Pediatrics and Columbus Children's Research Institute, The Ohio State University, Columbus (Dr Bridge); Department of Psychiatry and Western Psychiatric Institute & Clinic (Drs Iyengar, Salary, Barbe, Birmaher, and Brent) and Department of Statistics (Drs Iyengar and Ren), University of Pittsburgh, Pittsburgh, Pa; Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland (Dr Barbe); Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY (Dr Pincus); and the RAND Corporation, Santa Monica, Calif (Dr Pincus). Dr Ren is now with Amgen Inc, San Francisco, Calif.
Posted by Jay on April 19, 2007, at 18:08:33
In reply to Analysis- less suicide risk-ADs better for anxiety, posted by psychobot5000 on April 18, 2007, at 15:51:44
Sorry for not putting the trigger in the subject...
From what I recall reading about suicide and psych meds, the atypical antipsychotics, in particular Zyprexa, has been shown to work best for suicidal ideation. It seems that almost everybody is blaming Zyprexa for *something* these days, but in my own personal experience, it is the only med that keeps the dysphoric mania, with it's extreme anxiety at bay. I may be a tad more tired, and put on an extra pound or so, but I have found Zyprexa invaluable. It also would seem to work for agitated depression, which may just be a 'soft' bipolar condition.
Posted by nellie7 on April 20, 2007, at 7:51:55
In reply to Antipsychotics guard against suicidal thoughts., posted by Jay on April 19, 2007, at 18:08:33
In some people APs may worsen suicidal feelings.Nellie.
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