Selective Serotonin Reuptake Inhibitors Versus Tricyclic Antidepressants In Children And Adolescents Depression:a Meta-Analysis

Objective:A meta-analysis comparing the efficacy and acceptability of selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) in depressed children and adolescents depression was performed.Methods:A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science, PsychINFO, CNKI, WanFang and VIP was conducted from inception to December 2013. Only clinical trials that randomly assigned one SSRI or TCA to children and/or adolescents who met the diagnostic criteria for unipolar depressive disorder were included. According to the inclusion and exclusion criteria, data of the included studies were extracted, and the methodological quality was evaluated. Then, meta-analysis was performed using RevMan 5.2 and STATA 12.0.Results:Four trials consisting of 360 patients were considered to be eligible for inclusion (181 patients for SSRIs and 179 patients for TCAs). SSRIs were significantly more effective than TCAs in change scores in depression rating scale [SMD=-0.57,95%CI(-0.95,-0.19), P=0.003]. SSRIs patients showed a significantly greater remission to depressive symptoms than TCAs patients [RR=1.39,95%CI(1.14,1.70), P=0.001]. Significantly more TCAs patients discontinued treatment than SSRIs patients [RR=0.71,95%CI(0.53,0.97), P=0.03]. There were no significant differences in the discontinued treatment due to adverse effects [RR=0.55, 95%CI(0.18,1.75), P=0.31] and suicide-related risk outcomes [RR=1.26, 95%CI(0.56,2.87), P=0.58] between SSRIs and TCAs.Conclusions:SSRIs therapy displays a superior efficacy and is better acceptability compared to TCAs therapy in children and adolescents depression.