Summary of findings for the main comparison. Tricyclic antidepressants for depression in children and adolescents.
| Tricyclic drugs for depression in children and adolescents | ||||||
| Patient or population: children and adolescents with depression Settings: inpatients or outpatients Intervention: tricyclic drugs | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Tricyclic drugs | |||||
|
Achieved recovery according to predetermined criteria (no longer meeting criteria for depression on K‐SADS or meeting a priori criteria for response on a depression checklist, assessed between 4 and 10 weeks of onset of treatment) |
450 per 1000 | 482 per 1000 (410 to 567) | RR 1.07 (0.91 to 1.26) | 453 (9 studies) | ⊕⊕⊝⊝ low1,2 | |
|
Change in depression checklist scores (BID, CDI, CDRS, DACL or HAM‐D from baseline to between 2 and 10 weeks) |
The mean depression checklist score in the intervention groups was
0.32 standard deviations lower
(0.59 to 0.04 lower) This equates to a 3.3 (6.1 to 0.4) point reduction on the CDRS‐R (range 17 to 113) |
533 (13 studies) | ⊕⊕⊝⊝ low1,2,3 | SMD ‐0.32 (‐0.59 to ‐0.04) Subgroup analyses for children and adolescents found SMDs of 0.15 and ‐0.45, respectively, but the CIs overlapped |
||
|
Change in clinical global assessment scale scores (CGI scale or CGAS rated between 4 and 10 weeks of onset of treatment) |
The mean clinical global assessment scale score in the intervention groups was
0.1 standard deviations lower
(0.4 lower to 0.2 higher) This equates to 3 points lower to 1.5 points higher on the CGAS (range 0‐100) |
180 (5 studies) | ⊕⊕⊝⊝ low1,2,4 | SMD ‐0.1 (‐0.4 to 0.2) | ||
|
Number of withdrawals (occurring between 4 and 10 weeks of onset of treatment) |
200 per 1000 | 292 per 1000 (179 to 440) | OR 1.65 (0.87 to 3.14) | 462 (8 studies) | ⊕⊕⊝⊝ low1,5 | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BID: Bellevue Index of Depression; CDI: Children's Depression Inventory; CDRS: Children's Depression Rating Scale; CGAS: Clinical Global Assessment Scale; CGI: Clinical Global Impression; CI: confidence interval; DACL: Depressive Adjective Checklist; HAM‐D: Hamilton Depression Rating Scale; OR: odds ratio; SMD: standardised mean difference. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Study methodology not robust in many studies, primarily due to age of study 2 Confidence intervals for analysis include both appreciable benefit and appreciable harm 3 Not all confidence intervals overlap. I2 is 50%. 4 Small sample size; less than 400 participants 5 Wide confidence intervals