Which SSRIs most effectively treat depression in adolescents?

Abstract

Q: Which SSRIs most effectively treat depression in adolescents? Evidence-based answer: We don' t know which selective serotonin reuptake inhibitors (SSRIs) are the most effective and safe because no studies have compared these antidepressants with each other. Three SSRI antidepressant medications--fluoxetine, sertraline, and escitalopram--produce modest improvements (about 5% to 10%) in standardized depression scores without a significant increase in the risk of suicide-related outcomes (suicidal behavior or ideation) in adolescent patients with major depression of moderate severity. As a group, however, the newer-generation antidepressants, including SSRIs, increase suicide-related outcomes by 50%. Citalopram, paroxetine, venlafaxine, and mirtazapine don' t improve depression scores (strength of recommendation [SOR]: A, meta-analyses of randomized controlled trials [RCTs]). An updated national guideline recommends specific psychological therapy for adolescents with mild depression and combined psychotherapy and fluoxetine for moderate or severe depression, with sertraline or citalopram as second-line agents (SOR: A, RCTs).