Skip to main content
×
Home

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)
Abstract

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.

Copyright
Corresponding author
*Address for correspondence: Dejan Stevanovic, MD, Department of Psychiatry, General Hospital Sombor, Apatinski put 38, 25000 Sombor, Serbia. Email dejanstevanovic@eunet.rs
References
Hide All
1. Hennessy CH, Moriarty DG, Zack MM, etal. Measuring health-related quality of life for public health surveillance. Public Health Rep. 1994; 109(5): 665672.
2. Acquadro C, Berzon R, Dubois D, etal. Incorporating the patient's perspective into drug development and communication: an Ad Hoc Task Force report on the Patient-Reported Outcomes (PRO) Harmonization Group Meeting at the Food and Drug Administration, February 16, 2001. Value Health. 2003; 5: 522531.
3. Chassany O, Sagnier P, Marquis P, 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. Fayers PM, Machin D. Quality of Life: The Assessment, Analysis and Interpretation of Patient-Reported Outcomes, 2nd ed. Chichester, UK: John Wiley & Sons; 2007.
5. Dey M, Landolt MA, Mohler-Kuo M. Health-related quality of life among children with mental disorders: a systematic review. Qual Life Res. 2012; 21(10): 17971814.
6. Sawyer MG, Whaites L, Rey JM, etal. Health-related quality of life of children and adolescents with mental disorders. J Am Acad Child Adolesc Psychiatry. 2002; 41(5): 530537.
7. Bastiaansen D, Koot HM, Ferdinand RF, Verhulst FC. Quality of life in children with psychiatric disorders: self-, parent, and clinician report. J Am Acad Child Adolesc Psychiatry. 2004; 43(2): 221230.
8. Karande S, Bhosrekar K, Kulkarni M, Thakker A. Health-related quality of life of children with newly diagnosed specific learning disability. J Trop Pediatr. 2009; 55(3): 160169.
9. Kuhlthau K, Orlich F, Hall T, 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. Matza LS, Rentz AM, Secnik K, 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. Rotsika V, Coccossis M, Vlassopoulos M, 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. Escobar R, Soutullo CA, Hervas A, 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. Bastiaansen D, Koot HM, Ferdinand RF. Psychopathology in children: improvement of quality of life without psychiatric symptom reduction? Eur Child Adolesc Psychiatry. 2005; 14(7): 364370.
14. Katschnig H. Quality of life in mental disorders: challenges for research and clinical practice. World Psychiatry. 2006; 5(3): 139145.
15. Committee for Medicinal Products for Human Use (CMPH). Reflection paper on the regulatory guidance for the use of health related quality of life (HRQL) measures in the evaluation of medicinal products. London: European Medicines Agency. http://www.emea.europa.eu/pdfs/human/ewp/13939104en.pdf (Accessed July 25, 2005).
16. U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research. Guidance for industry: patient-reported outcome measures—use in medical product development to support labeling claims. Federal Register. 2009; 74: 6513265133.
17. Revicki D, Erickson PA, Sloan JA, etal. Interpreting and reporting results based on patient-reported outcomes. Value Health. 2007; 10: S116S124.
18. Brundage M, Bass B, Davidson J, 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. IsHak WW, Greenberg JM, Balayan K, etal. Quality of life: the ultimate outcome measure of interventions in major depressive disorder. Harv Rev Psychiatry. 2011; 19(5): 229239.
20. Olatunji BO, Cisler JM, Tolin DF. Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev. 2007; 27(5): 572581.
21. Danckaerts M, Sonuga-Barke JS, Banaschewski T, etal. The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry. 2010; 19(2): 83105.
22. Vitiello B, Rohde P, Silva S, 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. Donnelly CL, Wagner KD, Rynn M, etal. Sertraline in children and adolescents with major depressive disorder. J Am Acad Child Adolesc Psychiatry. 2006; 45(10): 11621170.
24. Murray ML, de Vries CS, Wong IC. A drug utilization study of antidepressants in children and adolescents using the General Practice Research Database. Arch Dis Child. 2004; 89(12): 10981102.
25. Zito JM, Tobi H, de Jong-van den Berg LT, etal. Antidepressant prevalence for youths: a multi-national comparison. Pharmacoepidemiol Drug Saf. 2006; 15(11): 793798.
26. Dean AJ, Hendy A, McGuire T. Antidepressants in children and adolescents—changes in utilization after safety warnings. Pharmacoepidemiol Drug Saf. 2007; 16(9): 10481053.
27. Wijlaars LPMM, Nazareth I, Petersen I. 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. Clarke SA, Eiser C. The measurement of health related quality of life (QOL) in pediatric clinical trials: a systematic review. Health Qual Life Outcomes. 2004; 2: 66.
29. Solans M, Pane S, Estrada MD, 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.
30. Hazell P, O'Connell D, Heathcote D, Henry D. Tricyclic drugs for depression in children and adolescents. Cochrane Database Syst Rev. 2002; (2): CD002317.
31. Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN. Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database Syst Rev. 2012; 11: CD004851.
32. Henry A, Kisicki MD, Varley C. Efficacy and safety of antidepressant drug treatment in children and adolescents. Mol Psychiatry. 2012; 17(12): 11861193.
33. Efficace F, Bottomley A, Osoba D, 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.
34. Brundage M, Bass B, Davidson J, 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.
35. Cohen J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.
36. Byford S, Barrett B, Roberts C, 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. Goodyer IM, Dubicka B, Wilkinson P, 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. Goodyer I, Dubicka B, Wilkinson P, 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. Wagner KD, Ambrosini P, Rynn M, 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. Rynn M, Wagner KD, Donnelly C, etal. Long-term sertraline treatment of children and adolescents with major depressive disorder. J Child Adolesc Psychopharmacol. 2006; 16(1–2): 103116.
41. Domino ME, Foster EM, Vitiello B, 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. Isolan L, Pheula G, Salum GA Jr, etal. An open-label trial of escitalopram in children and adolescents with social anxiety disorder. J Child Adolesc Psychopharmacol. 2007; 17(6): 751760.
43. EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16(3):199–208.
44. Endicott J, Nee J, Yang R, Wohlberg C. 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. Patrick DL, Edwars TC, Topolski TD. Adolescent quality of life, part II: initial validation of a new instrument. J Adolesc. 2002; 25(3): 287300.
46. Poznanski E, Mokros H. Children's Depression Rating Scale—Revised (CDRS-R). Los Angeles, CA: WPS; 1995.
47. Birmaher B, Brent DA, Chiappetta L, 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. Papakostas GI, Petersen T, Mahal Y, etal. Quality of life assessments in major depressive disorder: a review of the literature. Gen Hosp Psychiatry. 2004; 26: 1317.
49. Stevanovic D. Impact of emotional and behavioral symptoms on quality of life in children and adolescents. Qual Life Res. 2013; 22(2): 333337.
50. Reed C, Monz BU, Perahia DG, 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. Angermeyer MC, Holzinger A, Matschinger H, Stenger-Wenzke K. Depression and quality of life: results of a follow-up study. Int J Soc Psychiatry. 2002; 48(3): 189199.
52. Rapaport MH, Clary C, Fayyad R, Endicott J. Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry. 2005; 162(6): 11711178.
53. Wille N, Badia X, Bonsel G, etal. Development of the EQ-5D-Y: a child-friendly version of the EQ-5D. Qual Life Res. 2010; 19(6): 875886.
54. Upton P, Lawford J, Eiser C. Parent–child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res. 2008; 17(6): 895913.
55. Johnston BC, Thorlund K, Schünemann HJ. 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. Calvert M, Blazeby J, Altman DG, etal. Reporting of patient-reported outcomes in randomized trials: the CONSORT PRO extension. JAMA. 2013; 309(8): 814822.
57. Coghill D. 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? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Stevanovic Supplementary Material
Appendix

 Word (46 KB)
46 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 6
Total number of PDF views: 74 *
Loading metrics...

Abstract views

Total abstract views: 416 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th November 2017. This data will be updated every 24 hours.