SynthesisJournal of the American Academy of Child and Adolescent Psychiatry2020
Antidepressant Tolerability in Pediatric Anxiety and Obsessive-Compulsive Disorders: A Bayesian Hierarchical Modeling Meta-analysis.
Synthesis in Journal of the American Academy of Child and Adolescent Psychiatry, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 4 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- The Impact of Development on Antidepressant and Placebo Response in Anxiety Disorders: A Bayesian Hierarchical Meta-Analytic Examination of Randomized Controlled Trials in Children, Adolescents, and Adults.Journal of child and adolescent psychopharmacology · 2024Pooled it
- What Is the Added Benefit of Combining Cognitive Behavioral Therapy and Selective Serotonin Reuptake Inhibitors in Youth with Obsessive Compulsive Disorder? A Bayesian Hierarchical Modeling Meta-Analysis.Journal of child and adolescent psychopharmacology · 2023Pooled it
- Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A Genotypes and Serotonin Reuptake Inhibitor Antidepressants.Clinical pharmacology and therapeutics · 2023Guideline
- The Impact of Failed Antidepressant Trials on Outcomes in Children and Adolescents with Anxiety and Depression: A Systematic Review and Meta-Analysis.Journal of child and adolescent psychopharmacology · 2021Pooled it
- Acute Neurofunctional Effects of Escitalopram in Pediatric Anxiety: A Double-Blind, Placebo-Controlled Trial.Journal of the American Academy of Child and Adolescent Psychiatry · 2021Trial
- Treatment-Resistant Depression in Adolescents: Clinical Features and Measurement of Treatment Resistance.Journal of child and adolescent psychopharmacology · 2020Trial
- Pharmacological treatment of obsessive-compulsive disorder in children and adolescents: An overview.World journal of clinical pediatrics · 2026Review
- Distinct Trajectories of Amygdala Connectivity Patterns Characterize Remission vs. Non-Remission in Patients With Major Depressive Disorder.Depression and anxiety · 2026Article
- Stepped Care Versus Stratified Care for Youth with Anxiety Disorders: a Pilot Randomized Controlled Trial.Child psychiatry and human development · 2025Article
- Pharmacogenetic Testing of Children and Adolescents with Mental Health Conditions: Real-World Experiences.Pharmaceuticals (Basel, Switzerland) · 2025Article
- A systematic review of selective serotonin reuptake inhibitor (SSRI)-induced activation and manic/hypomanic switch in children and adolescents.Scandinavian journal of child and adolescent psychiatry and psychology · 2025Review
- Assessing access: Texting hotline app provides mental health crisis care for economically deprived youth.Social science & medicine (1982) · 2024Article
- Gene-based drug therapy for children and youth treated with psychoactive medications.Paediatrics & child health · 2024Article
- La pharmacothérapie en fonction des gènes chez les enfants et les adolescents qui prennent des médicaments psychoactifs.Paediatrics & child health · 2024Article
- Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents.Pharmacotherapy · 2023Review
- Cognitive Behavioral Therapy for Anxiety Disorders in Youth: Efficacy, Moderators, and New Advances in Predicting Outcomes.Current psychiatry reports · 2022Review
- Pediatric Psychopharmacology for Depressive and Anxiety Disorders.Focus (American Psychiatric Publishing) · 2022Review
- Adolescent Depression and Anxiety Treatment in Rural Schools: A Systematic Review.Rural mental health · 2022Article
- Article
- Computational Predictions for OCD Pathophysiology and Treatment: A Review.Frontiers in psychiatry · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo 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).
methodMEDLINE, 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.
resultsData 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.
conclusionIn 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.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.