Cipriani and colleagues published a network meta-analysis in the Lancet this year with the aim of ranking and comparing efficacy of antidepressants and placebo in treating major depressive disorder in young people.

They commented that in many instances studies exhibited poor methodology, risk bias and potential selective reporting which could not be verified without access to patient level data. Only fluoxetine was significantly more effective than placebo, with its upper limit being very close to the point of no difference.

Furthermore there was an increased risk of suicidal behaviour or ideation with venlafaxine, although data for many other drugs was lacking. Clinical interpretation of other findings was hampered by the small number of trials in each node.  

This study highlights that there is little evidence of efficacy of antidepressants in the younger population, except possibly for fluoxetine. Clinical guidelines recommend psychotherapy as the first-line intervention of choice, with pharmacological management limited to severe cases and those not responding to psychotherapy.