Fluoxetine is still recommended as 1st-line antidepressant (AD) for pediadric depression. Look at the results from the Cochrane 2021 review. All ADs perform poorly, incl. fluox. which is certainly in the clinically irrelevant range. Doesn't take much AEs to create a problematic harm-benefit ratio. - ThreadSky

ploederl.bsky.social • 1 day ago

Fluoxetine is still recommended as 1st-line antidepressant (AD) for pediadric depression. Look at the results from the Cochrane 2021 review. All ADs perform poorly, incl. fluox. which is certainly in the clinically irrelevant range. Doesn't take much AEs to create a problematic harm-benefit ratio.

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newyorknp.bsky.social•20 hours ago

They're not looking at the pharmacogenetics. An antidepressant that works in one person, may not work in another. For many people, prozac isn't metabolised properly. This makes it difficult to create a first choice anything. I feel like precision medicine is catching up; this analysis is flawed.

joarhalvorsen.bsky.social•1 day ago

How does psychotherapy perform for pediatric depression?

ploederl.bsky.social•1 day ago

This is from the supplement of Zhuo et al.'s network MA
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30137-1/fulltext

joarhalvorsen.bsky.social•1 day ago

But Zhuo et al. reports SMDs, whereas the figure from Cochrane reports raw scores? What does a change of 5 points on the CDRS translate into SMD?

ploederl.bsky.social•1 day ago

Couldn't find a MA with mean differences in CDRS-scores.
Hetrick et al. suggest to use a SD of about 14 to translate CDRS-scores to SMDs, so this would be SMD 0.35.
My point was not to compare AD with PT, but to criticize the recommendation for fluoxetine vs. other ADs.

tkaiser.science•1 day ago

From looking at the network plot alone, we would have a much better grasp of the relative efficacy if similar resources were available for PT trials.

joarhalvorsen.bsky.social•1 day ago

I see. Neither psychopharmalogical nor psychological treatments for pediatric depression achieves treatment effects compared to placebo we can be comfortable with. But the again we need to keep in mind the substantial placebo/regression to the mean effects for depressive disorders.

ploederl.bsky.social•1 day ago

Agree. And with this evidence it's important to consider watchful waiting and patient preferences.
Unfortunately, it is common to equal "no prescription" with "untreated".

joarhalvorsen.bsky.social•1 day ago

Perhaps a controversial take: When it comes to depressive disorders few patients achieves good outcomes of psychopharmacological or psychological treatments relative to placebo, but most patients still get better (by themselves).

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