Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 2
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Lopresti, Adrian L. 2015. A review of nutrient treatments for paediatric depression. Journal of Affective Disorders, Vol. 181, p. 24.

    Golub, Mari S. Hogrefe, Casey E. and Bulleri, Alicia M. 2016. Peer social interaction is facilitated in juvenile rhesus monkeys treated with fluoxetine. Neuropharmacology, Vol. 105, p. 553.


Are antidepressants effective in quality of life improvement among children and adolescents? A systematic review

  • Dejan Stevanovic (a1), Ivana Tadic (a2) and Rajna Knez (a3)
  • DOI:
  • Published online: 13 September 2013

There is some evidence indicating that psychotropic medications might lead to health-related quality of life (QOL) improvements among children and adolescents with psychiatric disorders. The aim of this systematic review is to assess evidence regarding whether antidepressant treatment improves QOL among children and adolescents with depressive or anxiety disorders. A comprehensive search resulted in 5 clinical trials to be included in this review: 4 trials with major depressive disorder (MDD) and 1 trial with social anxiety disorder (SAD). In one MDD trial, fluoxetine combined with cognitive behavior therapy (CBT) significantly improved QOL compared to fluoxetine or CBT alone (effect sizes were 0.53 and 0.69, respectively). In 2 combined trials, sertraline alone significantly improved QOL among adolescents with MDD (effect size was 0.29), but not among children with MDD. Essentially, it was observed that antidepressants in these trials had minor positive effects on QOL improvement, which were lower than their potential to improve depressive symptoms. Although fluoxetine with CBT or sertraline monotherapy were shown to have some potential to improve QOL, this systematic review found inconclusive evidence that antidepressant treatments improve QOL among children and adolescents with depressive or anxiety disorders. More research is required, considering that QOL is currently under-evaluated in clinical trials with antidepressants among children and adolescents and available trials have limited methodological quality when reporting QOL data.

Corresponding author
*Address for correspondence: Dejan Stevanovic, MD, Department of Psychiatry, General Hospital Sombor, Apatinski put 38, 25000 Sombor, Serbia. Email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

3.O Chassany , P Sagnier , P Marquis , etal. Patient-reported outcomes: the example of health-related quality of life—a European guideline document for the improved integration of health-related quality of life assessment in the drug regulatory process. Drug Information Journal. 2002; 36(1): 209238.

4.PM Fayers , D Machin . Quality of Life: The Assessment, Analysis and Interpretation of Patient-Reported Outcomes, 2nd ed. Chichester, UK: John Wiley & Sons; 2007.

5.M Dey , MA Landolt , M Mohler-Kuo . Health-related quality of life among children with mental disorders: a systematic review. Qual Life Res. 2012; 21(10): 17971814.

6.MG Sawyer , L Whaites , JM Rey , etal. Health-related quality of life of children and adolescents with mental disorders. J Am Acad Child Adolesc Psychiatry. 2002; 41(5): 530537.

7.D Bastiaansen , HM Koot , RF Ferdinand , FC Verhulst . Quality of life in children with psychiatric disorders: self-, parent, and clinician report. J Am Acad Child Adolesc Psychiatry. 2004; 43(2): 221230.

8.S Karande , K Bhosrekar , M Kulkarni , A Thakker . Health-related quality of life of children with newly diagnosed specific learning disability. J Trop Pediatr. 2009; 55(3): 160169.

9.K Kuhlthau , F Orlich , T Hall , etal. Health-related quality of life in children with autism spectrum disorders: results from the Autism Treatment Network. J Autism Dev Disord. 2010; 40(6): 721729.

10.LS Matza , AM Rentz , K Secnik , etal. The link between health related quality of life and clinical symptoms among children with attention-deficit hyperactivity disorder. J Dev Behav Pediatr. 2004; 25(3): 166174.

11.V Rotsika , M Coccossis , M Vlassopoulos , etal. Does the subjective quality of life of children with specific learning disabilities (SpLD) agree with their parents’ proxy reports? Qual Life Res. 2011; 20(8): 12711278.

12.R Escobar , CA Soutullo , A Hervas , etal. Worse quality of life for children with newly diagnosed attention-deficit/hyperactivity disorder, compared with asthmatic and healthy children. Pediatrics. 2005; 116(3): e364e369.

13.D Bastiaansen , HM Koot , RF Ferdinand . Psychopathology in children: improvement of quality of life without psychiatric symptom reduction? Eur Child Adolesc Psychiatry. 2005; 14(7): 364370.

17.D Revicki , PA Erickson , JA Sloan , etal. Interpreting and reporting results based on patient-reported outcomes. Value Health. 2007; 10: S116S124.

18.M Brundage , B Bass , J Davidson , etal. Patterns of reporting health-related quality of life outcomes in randomized clinical trials: implications for clinicians and quality of life researchers. Qual Life Res. 2011; 20(5): 653664.

19.WW IsHak , JM Greenberg , K Balayan , etal. Quality of life: the ultimate outcome measure of interventions in major depressive disorder. Harv Rev Psychiatry. 2011; 19(5): 229239.

20.BO Olatunji , JM Cisler , DF Tolin . Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev. 2007; 27(5): 572581.

21.M Danckaerts , JS Sonuga-Barke , T Banaschewski , etal. The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry. 2010; 19(2): 83105.

22.B Vitiello , P Rohde , S Silva , etal. Functioning and quality of life in the Treatment for Adolescents with Depression Study (TADS). J Am Acad Child Adolesc Psychiatry. 2006; 45(12): 14191426.

23.CL Donnelly , KD Wagner , M Rynn , etal. Sertraline in children and adolescents with major depressive disorder. J Am Acad Child Adolesc Psychiatry. 2006; 45(10): 11621170.

24.ML Murray , CS de Vries , IC Wong . A drug utilization study of antidepressants in children and adolescents using the General Practice Research Database. Arch Dis Child. 2004; 89(12): 10981102.

25.JM Zito , H Tobi , LT de Jong-van den Berg , etal. Antidepressant prevalence for youths: a multi-national comparison. Pharmacoepidemiol Drug Saf. 2006; 15(11): 793798.

26.AJ Dean , A Hendy , T McGuire . Antidepressants in children and adolescents—changes in utilization after safety warnings. Pharmacoepidemiol Drug Saf. 2007; 16(9): 10481053.

27.LPMM Wijlaars , I Nazareth , I Petersen . Trends in depression and antidepressant prescribing in children and adolescents: a cohort study in The Health Improvement Network (THIN). PLoS ONE. 2012; 7(3): e33181.

28.SA Clarke , C Eiser . The measurement of health related quality of life (QOL) in pediatric clinical trials: a systematic review. Health Qual Life Outcomes. 2004; 2: 66.

29.M Solans , S Pane , MD Estrada , etal. Health-related quality of life measurement in children and adolescents: a systematic review of generic and disease-specific instruments. Value Health. 2008; 11(4): 742764.

32.A Henry , MD Kisicki , C Varley . Efficacy and safety of antidepressant drug treatment in children and adolescents. Mol Psychiatry. 2012; 17(12): 11861193.

33.F Efficace , A Bottomley , D Osoba , etal. Beyond the development of health-related quality of life (HRQOL) measures: a checklist for evaluating HRQOL outcomes in cancer clinical trials—does HRQOL evaluation in prostate cancer research inform clinical decision-making? J Clin Oncol. 2003; 21(18): 35023511.

35.J Cohen . Statistical Power Analysis for the Behavioral Sciences, 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.

36.S Byford , B Barrett , C Roberts , etal. Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive behavioural therapy in adolescents with major depression. Br J Psychiatry. 2007; 191: 521527.

37.IM Goodyer , B Dubicka , P Wilkinson , etal. A randomised controlled trial of cognitive behaviour therapy in adolescents with major depression treated by selective serotonin reuptake inhibitors: the ADAPT trial. Health Technol Assess. 2008; 12(14): iiiiv;, ix–60.

38.I Goodyer , B Dubicka , P Wilkinson , etal. Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behavior therapy in adolescents with major depression: randomized controlled trial. BMJ. 2007; 335(7611): 142.

39.KD Wagner , P Ambrosini , M Rynn , etal. Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder: two randomized controlled trials. JAMA. 2003; 290(8): 10331041.

40.M Rynn , KD Wagner , C Donnelly , etal. Long-term sertraline treatment of children and adolescents with major depressive disorder. J Child Adolesc Psychopharmacol. 2006; 16(1–2): 103116.

41.ME Domino , EM Foster , B Vitiello , etal. Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial. J Am Acad Child Adolesc Psychiatry. 2009; 48(7): 711720.

42.L Isolan , G Pheula , GA Salum Jr, etal. An open-label trial of escitalopram in children and adolescents with social anxiety disorder. J Child Adolesc Psychopharmacol. 2007; 17(6): 751760.

44.J Endicott , J Nee , R Yang , C Wohlberg . Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q): reliability and validity. J Am Acad Child Adolesc Psychiatry. 2006; 45(4): 401407.

45.DL Patrick , TC Edwars , TD Topolski . Adolescent quality of life, part II: initial validation of a new instrument. J Adolesc. 2002; 25(3): 287300.

47.B Birmaher , DA Brent , L Chiappetta , etal. Psychometric properties of the Screen for Child and Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. 1999; 38(10): 12301236.

48.GI Papakostas , T Petersen , Y Mahal , etal. Quality of life assessments in major depressive disorder: a review of the literature. Gen Hosp Psychiatry. 2004; 26: 1317.

49.D Stevanovic . Impact of emotional and behavioral symptoms on quality of life in children and adolescents. Qual Life Res. 2013; 22(2): 333337.

50.C Reed , BU Monz , DG Perahia , etal. Quality of life outcomes among patients with depression after 6 months of starting treatment: results from FINDER. J Affect Disord. 2009; 113: 296302.

51.MC Angermeyer , A Holzinger , H Matschinger , K Stenger-Wenzke . Depression and quality of life: results of a follow-up study. Int J Soc Psychiatry. 2002; 48(3): 189199.

52.MH Rapaport , C Clary , R Fayyad , J Endicott . Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry. 2005; 162(6): 11711178.

53.N Wille , X Badia , G Bonsel , etal. Development of the EQ-5D-Y: a child-friendly version of the EQ-5D. Qual Life Res. 2010; 19(6): 875886.

54.P Upton , J Lawford , C Eiser . Parent–child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res. 2008; 17(6): 895913.

55.BC Johnston , K Thorlund , HJ Schünemann . Improving the interpretation of quality of life evidence in meta-analyses: the application of minimal important difference units. Health Qual Life Outcomes. 2010; 8: 116.

56.M Calvert , J Blazeby , DG Altman , etal. Reporting of patient-reported outcomes in randomized trials: the CONSORT PRO extension. JAMA. 2013; 309(8): 814822.

57.D Coghill . Pragmatic measures in paediatric psychopharmacology—are we getting it right? Eur Neuropsychopharmacol. 2011; 21(8): 571583.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

CNS Spectrums
  • ISSN: 1092-8529
  • EISSN: 2165-6509
  • URL: /core/journals/cns-spectrums
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary Materials

Stevanovic Supplementary Material

 Unknown (46 KB)
46 KB