• child psychiatry
• pharmacology

Antidepressants continue to generate controversy as a treatment for children and adolescents. Amidst this controversy, rates of emotional disorders in young people are rising and the vast majority of children and adolescents with mental health disorders do not receive treatment.1 Mood disorders remain a leading cause of adolescent suicide. This editorial will review the recent meta-analysis of antidepressants by Locher et al 2 and discuss the conclusions within the context of clinical practice and known flaws in the evidence base.

The review is an update on an earlier meta-analysis which also examined the effectiveness of selective serotonin reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants compared with placebo across a range of disorders. This adds greatly to meta-analyses that have focused on one disorder only, allowing conclusions to be made about difference in efficacy across different indications. The current review included 36 trials, 6778 participants and broadly reported similar conclusions: antidepressants appear to be more beneficial for anxiety disorders (10 trials, g=0.56, 95% CI 0.40 to 0.72, P<0.001) and obsessive-compulsive disorder (8 trials, g=0.39, 95% CI 0.25 to 0.54, P<0.001), compared with depressive disorders (17 trials, g=0.20, 95% CI 0.13 to 0.27, P<0.001). The depression–anxiety difference appears to be driven by a greater placebo response in depressive disorders; conversely response to both antidepressants and (especially) placebo is lower for OCD. Adverse effects are reported more frequently in children and young people taking antidepressants compared with placebo.

The authors discuss the issue of high placebo response in depression, and harnessing components of the placebo response in designing a low-intensity intervention. Indeed, in our recent IMPACT study, we unexpectedly found that a low-intensity brief psychosocial intervention, focused …