PMID- 31682918
OWN - NLM
STAT- MEDLINE
DCOM- 20210318
LR  - 20240216
IS  - 1527-5418 (Electronic)
IS  - 0890-8567 (Print)
IS  - 0890-8567 (Linking)
VI  - 59
IP  - 11
DP  - 2020 Nov
TI  - Antidepressant Tolerability in Pediatric Anxiety and Obsessive-Compulsive 
      Disorders: A Bayesian Hierarchical Modeling Meta-analysis.
PG  - 1240-1251
LID - S0890-8567(19)32113-6 [pii]
LID - 10.1016/j.jaac.2019.10.013 [doi]
AB  - OBJECTIVE: To compare adverse events (AEs), suicidality, and AE-related 
      discontinuation in double-blind, placebo-controlled trials of pediatric patients 
      with obsessive-compulsive disorder (OCD) and anxiety disorders treated with 
      selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine 
      reuptake inhibitors (SNRIs). METHOD: MEDLINE, PubMed, Web of Science, PsycINFO, 
      and Embase were searched for peer-reviewed, English-language articles from 
      inception through March 1, 2019. We identified prospective, randomized SSRI and 
      SNRI studies in patients <18 years of age with OCD or generalized, separation, or 
      social anxiety disorders. AE rates were extracted and medication-placebo 
      differences were examined using Bayesian hierarchical models, then posterior 
      estimates of relative risk (RR) were determined for each AE by medication class 
      and disorder. RESULTS: Data were included from 18 trials (2,631 patients) and 7 
      medications (16 SSRI and 4 SNRI trials). Compared with placebo, SSRIs were 
      associated with a greater likelihood of AE-related discontinuation (RR 3.59, 
      credible interval [CrI] 0.019-0.067, p = .0003), activation (RR 2.39, CrI 
      0.048-0.125, p = .003), sedation (RR 1.94, CrI 0.035-0.157, p = .002), insomnia 
      (RR 1.93, CrI 0.040-0.149, p = .001), abdominal pain (RR 1.53, CrI 0.032-0.164, 
      p = .005), and headache (RR 1.24, CrI 0.003-0.139, p = .04). Activation was more 
      common with SSRIs (versus SNRIs, RR 1.32, CrI 0.018-0.114, p = .007). Neither 
      SSRIs nor SNRIs were associated with treatment-emergent suicidality. CONCLUSION: 
      In pediatric OCD and anxiety disorders, SSRIs (compared with placebo) are 
      associated with distinct AEs and greater AE-related discontinuation, although 
      their tolerability does not differ between anxiety disorders and OCD. Compared 
      with SNRIs, SSRIs are more likely to produce activation. Class-related AEs are 
      important for clinicians to consider, particularly in light of data suggesting 
      differences in class-related efficacy. Whereas SSRIs are superior to SNRIs and 
      the treatment of choice for anxiety, for youths who become activated on SSRIs, 
      SNRIs might represent a good second choice given their reported efficacy and 
      lower risk of activation.
CI  - Copyright (c) 2019 American Academy of Child and Adolescent Psychiatry. Published 
      by Elsevier Inc. All rights reserved.
FAU - Mills, Jeffrey A
AU  - Mills JA
AD  - Carl H. Lindner College of Business, University of Cincinnati, Ohio.
FAU - Strawn, Jeffrey R
AU  - Strawn JR
AD  - College of Medicine, University of Cincinnati, and the Cincinnati Children's 
      Hospital Medical Center, Ohio. Electronic address: strawnjr@uc.edu.
LA  - eng
GR  - K23 MH106037/MH/NIMH NIH HHS/United States
GR  - R01 HD098757/HD/NICHD NIH HHS/United States
GR  - R01 HD099775/HD/NICHD NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20191101
PL  - United States
TA  - J Am Acad Child Adolesc Psychiatry
JT  - Journal of the American Academy of Child and Adolescent Psychiatry
JID - 8704565
RN  - 0 (Antidepressive Agents)
RN  - 0 (Serotonin Uptake Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Antidepressive Agents/therapeutic use
MH  - Anxiety
MH  - *Anxiety Disorders/drug therapy
MH  - Bayes Theorem
MH  - Child
MH  - Humans
MH  - *Obsessive-Compulsive Disorder/drug therapy
MH  - Prospective Studies
MH  - Randomized Controlled Trials as Topic
MH  - Selective Serotonin Reuptake Inhibitors/adverse effects
PMC - PMC8028746
MID - NIHMS1681053
OTO - NOTNLM
OT  - OCD
OT  - SNRI
OT  - SSRI
OT  - antidepressant
OT  - anxiety
EDAT- 2019/11/05 06:00
MHDA- 2021/03/19 06:00
PMCR- 2021/11/01
CRDT- 2019/11/05 06:00
PHST- 2019/05/22 00:00 [received]
PHST- 2019/09/24 00:00 [revised]
PHST- 2019/10/28 00:00 [accepted]
PHST- 2019/11/05 06:00 [pubmed]
PHST- 2021/03/19 06:00 [medline]
PHST- 2019/11/05 06:00 [entrez]
PHST- 2021/11/01 00:00 [pmc-release]
AID - S0890-8567(19)32113-6 [pii]
AID - 10.1016/j.jaac.2019.10.013 [doi]
PST - ppublish
SO  - J Am Acad Child Adolesc Psychiatry. 2020 Nov;59(11):1240-1251. doi: 
      10.1016/j.jaac.2019.10.013. Epub 2019 Nov 1.