BMJ 1995;311:390 (5 August)

Letters

Place of tricyclics in depression of young people is not proved

EDITOR,--P Hazell and colleagues address an important issue in their meta-analysis of the efficacy of tricyclic antidepressants in child and adolescent depression.1 Owing to deficiencies in both the material and analysis, however, it is vital that their results are taken to mean that the efficacy of such depressants is "not proved" rather than that they are ineffective in this situation.

Firstly, the authors do not discuss the diagnosis and severity of depression in the patients. In adult psychiatry "minor" and mild depression show less specific response to antidepressive drugs than more severe, "major" depression.2 It seems very likely, in view of the high placebo response in the studies analysed, that this might be true of the child and adolescent patients studied. Heterogeneity in the patient groups would weaken the power to detect differences in responses to drugs and placebos. Better definition of patients may identify a group of patients for . . . [Full text of this article]


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Relevant Article

Efficacy of tricyclic drugs in treating child and adolescent depression: a meta-analysis
P Hazell, D O'Connell, D Heathcote, J Robertson, and D Henry
BMJ 1995 310: 897-901. [Abstract] [Full Text]

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