Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents

Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescentsMajor depressive disorder is common in young people with an estimated point prevalence of 2.8% in school-age children (aged 6-12 years) and 5.6% in adolescents (aged 13-18 years). Psychological treatments are still considered the first-line treatments in many clinical guidelines but antidepressants are widely used.In this network meta-analysis the researchers have investigated the efficacy and tolerability of 14 antidepressant drugs. They found 34 eligible trials including 5,260 participants, in which the antidepressant used was compared with a placebo.They reached the conclusion that when considering the risk-benefit profile of antidepressants in the acute treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents. Fluoxetine is probably the best option to consider when a pharmacological treatment is indicated. Lancet 2016; 388: 881-90 Stockings to prevent post-thrombotic syndromeWhat is the effect of stopping elastic compression stocking (ECS) therapy 12 months after a diagnosis of proximal deep venous thrombosis versus continuing ECS for 24 months on the occurrence of post-thrombotic syndrome and disease specific quality of life?That is the question asked in this multicentre trial performed in the Netherlands. Five hundred and eighteen patients were randomised to either 12 or 24 months of treatment. The proportion of patients that developed the post-thrombotic syndrome was 19.9% in the group that stopped ECS at 12 months and 13% in those who continued ECS for 24 months. The authors estimate that 14 patients would have to continue ECS to prevent one case of post-thrombotic syndrome.They believe that ECS therapy should ideally be continued for 24 months in ECS compliant patients after deep venous thrombosis. BMJ 2016; 353: i2691 Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or olderA trial involving adults 50 years of age or older showed that the herpes zoster subunit vaccine (HZ/su) containing recombinant varicella-zoster virus glycoprotein E and the AS01B adjuvant system was associated with a risk of herpes zoster that was 97.2% lower than that associated with placebo.This report concerns a similar trial conducted in subjects 70 years of age or older. Thirteen thousand nine hundred participants (mean age 75.6 years) were randomised to receive either HZ/su or placebo. At 3.7 years follow-up the incidence of herpes zoster was 89.8% lower in those vaccinated with HZ/su compared with the placebo group. Serious adverse effects, potential immune-mediated diseases and deaths occurred with similar frequencies in the two groups.The researchers conclude that the use of HZ/su is efficacious and safe when used in adults 70 years of age or older. N Engl J Med 2016; 375: 1019-32