Tricyclic drugs for depression in children and adolescents

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. Prescribing of tricyclic drugs for depression in children and adolescents is now uncommon, but an accurate estimate of their efficacy is helpful as a comparator for other drug treatments for depression in this age group. This is an update of a Cochrane review first published in 2000 and updated in 2002, 2006 and 2010. Objectives To assess the effects of tricyclic drugs compared with placebo for depression in children and adolescents and to determine whether there are differential responses to tricyclic drugs between child and adolescent patient populations. Search methods We conducted a search of the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 12 April 2013), which includes relevant randomised controlled trials from the following bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (all years), EMBASE (1974‐), MEDLINE (1950‐) and PsycINFO (1967‐). The bibliographies of previously published reviews and papers describing original research were cross‐checked. We contacted authors of relevant s in conference proceedings of the American Academy of Child and Adolescent Psychiatry, and we handsearched the Journal of the American Academy of Child and Adolescent Psychiatry (1978 to 1999). Selection criteria Randomised controlled trials comparing the efficacy of orally administered tricyclic drugs with placebo in depressed people aged 6 to 18 years. Data collection and analysis One of two review authors selected the trials, assessed their quality, and extracted trial and outcome data. A second review author assessed quality and checked accuracy of extracted data. Most studies reported multiple outcome measures including depression scales and clinical global impression scales. For each study, we took the best available depression measure as the index measure of depression outcome. We established predetermined criteria to assist in the ranking of measures. Where study authors reported categorical outcomes, we calculated individual and pooled risk ratios for non‐improvement in treated compared with control subjects. For continuous outcomes, we calculated pooled effect sizes as the number of standard deviations by which the change in de