Tricyclic drugs for depressed children and adolescents

Hazell P, O'Connell D, Heathcote D, Henry DA

Published Online:

April 14, 2010

Tricyclic drugs do not seem useful for treating children before puberty, and are of moderate benefit at most for adolescents. Although tricyclic drugs are effective in treating adults with depression, it is not clear whether they are safe and effective for children and adolescents. This review found no difference in the rates of recovery from depression for people aged 6 to 18 years who took a tricyclic drug or a placebo. Treatment with tricyclic drugs resulted in a greater reduction in depressive symptoms than treatment with a placebo, but the effect was moderate and of questionable clinical importance. The treatment effect was larger in the studies that included only adolescents, while no difference was seen in studies that included only children before the age of puberty. Research should be directed towards evaluation of the newer antidepressant drugs and non-drug therapies.

Abstract (click to read)

Background:

There is a need to identify effective and safe treatments for depression in children and adolescents. While tricyclic drugs are effective in treating depression in adults, individual studies involving children and adolescents have been equivocal.

Objectives:

To assess the effects of oral tricyclic antidepressants compared to placebo in the treatment of child and adolescent depression.

Search strategy:

CCDANCTR-Studies and CCDANCTR-References were searched on 12/2/2008. The bibliographies of previously published reviews and papers describing original research were cross-checked. We contacted authors of relevant abstracts in conference proceedings of the American Academy of Child and Adolescent Psychiatry, and we hand searched the Journal of the American Academy of Child and Adolescent Psychiatry (1978-1999).

Selection criteria:

Randomised controlled trials comparing the efficacy of orally administered tricyclic medication with placebo in depressed people aged 6-18 years.

Data collection and analysis:

Most studies reported multiple outcome measures including depression scales and clinical global impression scales. For each study the best available depression measure was taken as the index measure of depression outcome. Predetermined criteria were established to assist in the ranking of measures. Where authors reported categorical outcomes we calculated individual and pooled odds ratios for the odds of improvement in treated compared with control subjects. For continuous outcomes pooled effect sizes were calculated as the number of standard deviations by which the change in depression scores for the treatment group exceeded those for the control groups.

Main results:

Thirteen trials (involving 506 participants) were included. No overall improvement with treatment compared to placebo was seen for children or adolescents (odds ratio = 0.84, 95% confidence interval 0.56 to 1.25). A statistically significant but small benefit of treatment over placebo was seen in reducing symptoms (effect size (standardised mean difference) = -0.31, 95% confidence interval -0.62 to -0.01). Subgroup analyses suggest a larger benefit among adolescents (effect size = -0.47, 95% confidence interval -0.92 to -0.02), and no benefit among children (effect size = 0.15, 95% confidence interval -0.34 to 0.64). Treatment with a tricyclic antidepressant caused more vertigo (odds ratio = 4.38, 95% confidence interval 2.33 to 8.25), orthostatic hypotension (odds ratio = 6.78, 95% confidence interval 2.06 to 22.26), tremor (odds ratio 6.29, 95% confidence interval 1.78 to 22.17) and dry mouth (odds ratio = 5.17, 95% confidence interval 2.68 to 29.99) than did placebo, but no statistically significant difference was found for other possible adverse effects.

Authors' conclusions:

Data suggest tricyclic antidepressants are not useful in treating depression in pre pubertal children. There is marginal evidence to support the use of tricyclic antidepressants in the treatment of depression in adolescents, although the magnitude of effect is likely to be moderate at best.

This record should be cited as:

Hazell P, O'Connell D, Heathcote D, Henry DA. Tricyclic drugs for depression in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002317. DOI: 10.1002/14651858.CD002317

Assessed as up to date:

February 12, 2008

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Depression, Anxiety and Neurosis Group

Health topics:

Mental health > Depression > Depressive disorders & major depression

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Tricyclic drugs for depressed children and adolescents

More like this

Copyright © 2011 - The Cochrane Collaboration