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Original ArticleOpen Access
Tricyclic Antidepressants for Depressive Disorders in Children and Adolescents : A Meta-Analysis of Randomized-Controlled Trials
Maneeton N 
,
Srisurapanont M
,
Srisurapanont M NARONG MANEETON, M.D.*,
MANIT SRISURAPANONT, M.D.*
The tricyclic antidepressants (TCAs) are effective for the treatment of adult depression.
However, their efficacy of these in the treatment of children and adolescents with depression is
equivocal. Therefore, it is necessary to determine the efficacy and acceptability of TCAs in the
treatment of depressive disorders in children and adolescents. The databases of MEDLINE (from
1966 to October 1999) and Controlled Clinical Trials Registered (from 1980 to October 1999) were
searched for randomized-controlled trials relevant to the use of TCAs for treating depressed
children and adolescents. The reviewers also examined the reference lists of identified papers and
that of a previous meta-analysis. In each trial, both nonresponse rates and dropout rates were taken
into account and extracted on an intention-to-treat basis. The nonresponse-rate and dropout-rate
odd ratios (ORs) with 95 per cent confidence intervals (95% Cis) of each trial and the pooled non-
response-rate and dropout-rate ORs (95% Cis) of all trials were computed. Nine trials included in
this meta-analysis were 2 amitriptyline, 3 desipramine, 2 imipramine, and 2 nortriptyline studies.
By using a fixed-effect model, the pooled nonresponse-rate OR (95% CI) and the pooled dropout
rate OR (95% CI) of antidepressant-treated group were 0.92 (0.57 to 1.47) and 2.14 (1.12 to 4.09),
respectively. In summary, the evidence so far does not support that TCAs are more effective or
more acceptable than placebo in the treatment of depressive disorders in children and adolescents.
However, the studies of selective serotonin reuptake inhibitors and newer antidepressants for the
treatment of these disorders should be further investigated.
Key word : Antidepressive-agent, Child, Adolescence, Depressive Disorders, Meta-analysis
MANIT SRISURAPANONT, M.D.*
The tricyclic antidepressants (TCAs) are effective for the treatment of adult depression.
However, their efficacy of these in the treatment of children and adolescents with depression is
equivocal. Therefore, it is necessary to determine the efficacy and acceptability of TCAs in the
treatment of depressive disorders in children and adolescents. The databases of MEDLINE (from
1966 to October 1999) and Controlled Clinical Trials Registered (from 1980 to October 1999) were
searched for randomized-controlled trials relevant to the use of TCAs for treating depressed
children and adolescents. The reviewers also examined the reference lists of identified papers and
that of a previous meta-analysis. In each trial, both nonresponse rates and dropout rates were taken
into account and extracted on an intention-to-treat basis. The nonresponse-rate and dropout-rate
odd ratios (ORs) with 95 per cent confidence intervals (95% Cis) of each trial and the pooled non-
response-rate and dropout-rate ORs (95% Cis) of all trials were computed. Nine trials included in
this meta-analysis were 2 amitriptyline, 3 desipramine, 2 imipramine, and 2 nortriptyline studies.
By using a fixed-effect model, the pooled nonresponse-rate OR (95% CI) and the pooled dropout
rate OR (95% CI) of antidepressant-treated group were 0.92 (0.57 to 1.47) and 2.14 (1.12 to 4.09),
respectively. In summary, the evidence so far does not support that TCAs are more effective or
more acceptable than placebo in the treatment of depressive disorders in children and adolescents.
However, the studies of selective serotonin reuptake inhibitors and newer antidepressants for the
treatment of these disorders should be further investigated.
Key word : Antidepressive-agent, Child, Adolescence, Depressive Disorders, Meta-analysis
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