The number of patients needed to be treated to gain an additional improvement was 9 for all SSRIs compared to placebo. For fluoxetine only it was 5. A number needed to treat of 9 is high and comes close to no use. A number of 5 tough sounds promising and is comparable to those reported for SSRIs in adults. Sertraline and citalopram showed only a moderate degree of efficacy and the other SSRIs a weak degree of efficacy.
This conclusion is based on a meta-analysis of 11 randomised controlled trials on the effect of SSRI treatment in children and adolescents with depression.
The randomised controlled trials were different in methodological approaches: enrolled population, sample size, diagnostic and outcome measures, and applied treatment schedule.
Nevertheless, with all these limitations SSRIs especially fluoxetine might be of benefit for severe or resistant depression in children and adolescents. Moreover, combination therapy with cognitive behavioral therapy in adolescents with moderate to severe depression is superior to medication or CBT alone. To my opinion this combination is the optimal treatment for severe or treatment resistant depression in adolescents and children.
The FDA black box warning for paroxetine in October 2004 resulted in a nonsignificant decline in antidepressant treatment of adolescents, including a significant deceleration in the rate of treatment with SSRIs other than paroxetine.
This outcome of a recent study published in the Archives of General Psychiatry of January 2008 neutralizes the concern expressed mostly by drug company supported publications about putting depressed youth at risk due to excessive decline in antidepressant prescribing.
USALA, T., CLAVENNA, A., ZUDDAS, A., BONATI, M. (2008). Randomised controlled trials of selective serotonin reuptake inhibitors in treating depression in children and adolescents: A systematic review and meta-analysis. European Neuropsychopharmacology, 18(1), 62-73. DOI: 10.1016/j.euroneuro.2007.06.001