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To the Editor: In their meta-analysis of trials of antidepressants in children and adolescents, Dr Bridge and colleagues¹ reported that drug class was not a significant moderator of efficacy for major depression. However, their binary classification of drugs as SSRIs or non-SSRIs failed to account for heterogeneity within the SSRI class. As the authors note, the long half-life of fluoxetine distinguishes it from other SSRIs.² Clinical differences among SSRIs have been attributed to their heterogeneous pharmacology.³ A systematic review of trials of SSRIs for pediatric depression concluded that fluoxetine has a more favorable risk-benefit profile than other SSRIs.⁴

The pooled estimates of efficacy in eTable 1, which accompanies the article by Bridge et al online, strongly suggest differential efficacy for major depression. There is limited overlap between the confidence intervals for fluoxetine and those for paroxetine and citalopram/escitalopram. Paroxetine was not significantly more effective than placebo. Since the data do . . . [Full Text of this Article]

Jonathan L. Edwards, MD
jedwards@barbhosp.com

Karen K. Kirk, MSSA, LISW
Department of Family Medicine
Barberton Citizens' Hospital
Barberton, Ohio

Chand K. Midha, PhD
Department of Statistics
University of Akron
Akron, Ohio

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