Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis
Open accessAbstract
Introduction: Depressive disorder is common in children and adolescents, with important consequences and serious impairments in terms of personal and social functioning. While both pharmacological and psychological interventions have been shown to be effective, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank in a network meta-analysis (NMA) the commonly used psychological, pharmacological and combined interventions for depressive disorder in children and adolescents. Methods and analysis: We will update the literature search of two previous NMAs for the identification of trials of antidepressant and psychotherapy alone for depressive disorder in children and adolescents. For identification of trials of combination interventions, seven databases (PubMed, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS) will be searched from date of inception. We will also search ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and check relevant reports on the US Food and Drug Administration website for unpublished data. Building on our previous findings in the field, we will include any commonly prescribed oral antidepressants and any manualised or structured psychotherapies, as well as their combinations. Randomised controlled trials assessing any active intervention against active comparator or pill placebo/psychological controls in acute treatment for depressive disorder in children and adolescents will be included. The primary outcomes will be efficacy (mean change in depressive symptoms), and acceptability of treatment (dropout rate due to any cause). The secondary outcomes will be remission rate, tolerability of treatment (dropouts for adverse events), as well as suicide-related outcomes (suicidal behaviour or ideation). We will perform Bayesian NMAs for all relative outcome measures. Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the findings. Dissemination: This NMA will provide the most up to date and clinically useful information about the comparative efficacy and acceptability of antidepressants, psychological intervention and their combination in the acute treatment of children and adolescents with depressive disorder. This is the newest NMA and therefore these results are very important in terms of evidence-based medicine. The results will be disseminated through peer-reviewed publication. Protocol registration: PROSPERO CRD42015020841.
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Risk of bias in included studies was assessed following the Cochrane Handbook for Systematic Reviews of Interventions.
“We assessed the studies' risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.14”
Transitivity was examined by comparing the distributions of clinical and methodological effect modifiers-such as age, sex, baseline depression severity, and treatment duration-across treatment comparisons.
“To assess transitivity, we compared the distribution of clinical and methodological variables (eg, age, sex, depressive severity at baseline, and treatment duration) that could act as effect modifiers across treatment com parisons.14”
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- Authors
- Zhou, X., Cipriani, A., Zhang, Y., Cuijpers, P., Hetrick, S. E., Weisz, J. R., Pu, J., Giovane, C. D., Furukawa, T. A., Barth, J., Coghill, D., Leucht, S., Yang, L., Ravindran, A. V., & Xie, P.
- Affiliations
- The Affiliated Yongchuan Hospital of Chongqing Medical University (CN)
- Oxford Health NHS Foundation Trust (GB)
- Amsterdam Public Health (NL)
- The University of Melbourne (AU)
- Harvard University (US)
- University of Modena and Reggio Emilia (IT)
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
- University of Zurich (CH)
- Technical University of Munich (DE)
- University of Toronto (CA)
- Corresponding author
- Xie, Peng
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-08
- Volume
- 7
- Issue
- 8
- Pages
- e016608
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5629731
- OpenAlex
- W2743730445
- Cited by
- 31
- References
- 47
- Citations by year
- 2023: 2 · 2022: 5 · 2021: 6 · 2020: 13 · 2019: 3 · 2018: 2
- FWCI
- 3.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by-nc)
- VU Research Portal (acceptedVersion, other-oa)
- Discovery Research Portal (University of Dundee) (submittedVersion, cc-by-nc)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Kyoto University Research Information Repository (Kyoto University) (submittedVersion, cc-by-nc)
- ResearchSpace (University of Auckland) (submittedVersion, cc-by-nc)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Basic Research Program of China
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- depressive disorders, children and adolescents, antidepressants, psychotherapy, combination therapy, treatment efficacy, treatment acceptability, dropout rates, remission, adverse events, acute treatment
- MeSH terms
- Network Meta-Analysis as Topic, Network Meta-Analysis, Adolescent, Antidepressive Agents, Child, Combined Modality Therapy, Depression, Depressive Disorder, Humans, Patient Dropouts, Psychotherapy, Research Design, Suicidal Ideation
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