Antidepressants use in children and adolescents and the risk of suicide.

OBJECTIVE: Antidepressants use in paediatric patients has been linked with risk of suicidal behaviours. The aim of this paper, therefore, is to examine whether all antidepressants are associated with such risk. METHOD: All 22 paediatric short-term placebo-controlled trials of SSRIs and NSRIs that were submitted to European registration authorities by pharmaceutical companies were identified and examined for events related to suicidality, which were defined as suicide, suicide attempts or suicidal thoughts. Random effect meta-analysis was used to combine the information from all trials. RESULTS: No completed suicides were reported. However, for each compound there was at least one study with an increased risk for events related to suicidality in the active compound group. The overall OR for these events in the depression studies was 1.67 (95% CI: 1.05-2.65) and for anxiety 1.33 (95% CI: 0.33-5.35). CONCLUSIONS: Caution is called for in the use of all SSRIs and NSRIs in the paediatric population. Furthermore, in the absence of contradictory information, caution in the use of other antidepressants in this population should be exercised as well (e.g. tricyclic antidepressants).

Response to tricyclic antidepressants: independent of gender?

OBJECTIVE: The authors examined gender differences in response to tricyclic antidepressants. METHOD: A total of 30 randomized, placebo-controlled trials that included 3,886 patients (1,555 men and 2,331 women), submitted between 1979 and 1991 in order to obtain marketing authorization, were reviewed. Gender differences in response to treatment were tested in various multiple regression models using a variety of response definitions. RESULTS: Different response definitions all pointed to no gender difference in the efficacy of tricyclic antidepressants. The estimated effect size was similar for women younger and older than age 50 and for men. CONCLUSIONS: Tricyclic antidepressant response is independent of gender.

Amisulpride: is there a treatment for negative symptoms in schizophrenia patients?

In this article we report on a meta-analysis of the published studies of amisulpride conducted in order to demonstrate efficacy on primary negative symptoms in schizophrenia. Four placebo-controlled studies were conducted in patients with predominantly negative symptoms. In all studies a significant improvement was observed on the Scale for the Assessment of Negative Symptoms (SANS) in the amisulpride groups (50-300 mg daily) as compared to placebo. The improvement on the SANS was not accompanied by a simultaneous improvement on the Scale for the Assessment of Positive Symptoms (SAPS) or a decrease in extrapyramidal symptoms (EPS) in three of the four studies, indicating a genuine effect on primary negative symptoms. The overall analysis shows that the improvement on the SANS was accompanied by a small simultaneous improvement on the SAPS. Moreover, in the studies where depressive symptoms were measured, a significant improvement was also shown in favor of amisulpride. However, as the SAPS and the Montgomery Asberg Depression Rating Scale (MADRS) baseline scores were rather low, the improvement on both scales in favor of amisulpride is probably not responsible for the improvement on the SANS. A positive correlation was found between the severity on the mean SANS score at baseline and mean improvement at endpoint, and a surprisingly high success rate was observed in the placebo groups, indicating either that primary negative symptoms are not as persistent as had previously been thought, or that the concept of primary negative symptoms should be reconsidered. Probably amisulpride is efficacious on these nonenduring primary negative symptoms.