Tricyclic drugs for depression in children and adolescents
Tricyclic drugs do not seem useful for treating children before puberty, and are, at most, of moderate benefit for adolescents.
Depression affects about one in 20 young people and can contribute to a variety of negative outcomes. 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 updated review aims to assess the effects of tricyclic dugs compared with placebo for depression in children and adolescents, whilst determining whether the response to tricyclic drugs differs between child and adolescent populations. Fourteen trials (with 590 participants) were included, and overall no difference was found for the primary outcome of response to treatment compared with placebo. There was a small reduction in depression symptoms, but the evidence was of low quality. Subgroup analysis suggested a small reduction in depression symptoms among adolescents, and negligible change among children. Treatment with a tricyclic antidepressant caused more vertigo, orthostatic hypotension, tremor and dry mouth than did placebo, but no differences were found for other possible adverse effects. There was typically insufficient information to judge the quality of the trials accurately. Data suggests tricyclic drugs are not useful in treating depression in children, however there is marginal evidence to support the use of tricyclic drugs for treatment of depression in adolescents.