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Randomised controlled trial
Both paroxetine and imipramine appear to be ineffective in adolescents with major depression, furthermore doubts have risen about their safety
  1. T K Birkenhager
  1. Erasmus MC Psychiatry, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to : Dr T K Birkenhager, Erasmus MC Psychiatry, University Medical Center Rotterdam, ‘s-Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; t.birkenhager{at}

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Adolescents suffering from major depression often receive treatment with antidepressants.

However the evidence for the efficacy of both newer antidepressants and tricyclic antidepressants in major depression in adolescence is very limited. Systematic reviews1 found a statistically significant difference in efficacy in favour of antidepressants versus placebo, which was not clinically relevant. However, they concluded that the large majority of studies on this topic shows serious methodological flaws, selecting patients with advertisements, excluding patients with suicide risk, high dropout rates and reporting bias. Regarding the use of selective serotonin reuptake inhibitors (SSRIs) there are indications of a slightly increased risk of suicide-related behaviour. Therefore, psychiatrists treating adolescents with major depression should consider psychological treatments such as cognitive behavioural therapy and other non-medication …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.