Forty-six studies met the inclusion criteria: 21 (>1,552 randomised) RCTs and 25 uncontrolled studies (n=539). Eighteen RCTs (n=1,405) and 23 uncontrolled studies (n=511) were included in the meta-analysis.
The quality scores for the controlled trials ranged from 0.31 to 0.91. The authors stated that there was no statistically detectable heterogeneity but provided no further details.
Controlled studies that evaluated tricyclics showed no significant benefit in response rates over placebo for children (OR 1.16, 95% confidence interval, CI: 0.33, 4.10; 5 studies), adolescents (OR 1.20, 95% CI: 0.74, 1.74; 8 studies) or all age groups together (OR 1.16, 95% CI: 0.74, 1.83; 13 studies).
Across all age groups, ORs for SSRIs were 1.84 (95% CI: 1.35, 2.50; 5 studies) for controlled studies and 1.83 (95% CI: 1.40, 2.40; 15 studies) for controlled and uncontrolled studies, suggesting a significant benefit over placebo.
Combining all studies favoured antidepressants over placebo: the OR was 1.52 (95% CI: 1.16, 1.98; 18 studies) for controlled studies and 1.59 (95% CI: 1.29, 1.96; 41 studies) for uncontrolled studies.