Review shows 'most convincing efficacy profile' for numerous youth psychiatric disorders

Researchers conducted an umbrella review of interventions for mental disorders among youths that provided evidence-based information for clinical decision making.

“Differences in inclusion criteria, outcomes and a variety of features defining quality across [meta-analyses] and [network meta-analyses] limit the clinical value and impact of such a rich, yet complex body of evidence,” Christoph U. Correll, MD, of the department of psychiatry at Zucker Hillside Hospital in New York, and colleagues wrote. “Umbrella reviews may overcome these problems to some degree by taking the totality of the evidence from existing [meta-analyses] and [network meta-analyses] into account, and filtering top-tier meta-analytic estimates according to pre-established criteria. It is paramount to provide clinicians with structured and standardized summaries, translating the massive data into actionable clinical information.”

According to the researchers, no umbrella review has yet analyzed evidence from meta-analyses and network meta-analyses of randomized controlled trials on the efficacy and acceptability of treatment options that incorporate pharmacological, psychosocial and brain stimulation interventions for the primary symptoms and related problems of the full range of youth mental disorders. Correll and colleagues aimed to address this research gap by systematically searching network meta-analyses and meta-analyses of randomized controlled trials that assess 48 medications, 20 psychosocial interventions and four brain stimulation techniques among children and adolescents with 52 different mental disorders or groups of mental disorders. Included studies reported on 20 different outcomes related to efficacy or acceptability. Disease-specific symptom reduction and all-cause discontinuation served as co-primary outcomes. The researchers included 14 network meta-analyses and 90 meta-analyses.

Results showed 21 medications outperformed placebo on the co-primary outcomes, as did three psychosocial interventions; seven psychosocial interventions outperformed waiting list/no treatment. The researchers noted the most convincing efficacy profile according to the meta-analytic evidence for amphetamines, methylphenidate and, to a lesser extent, behavioral therapy in ADHD; aripiprazole, risperidone and multiple psychosocial interventions in autism; risperidone and behavioral interventions in disruptive behavior disorders; multiple antipsychotics in schizophrenia spectrum disorders; fluoxetine and fluoxetine combined with cognitive behavioral therapy (CBT), as well as interpersonal therapy, in depression; aripiprazole in mania; fluoxetine and group CBT in anxiety disorders; fluoxetine/selective serotonin reuptake inhibitors, CBT and behavioral therapy featuring exposure and response prevention in OCD; CBT in PTSD; imipramine and alarm behavioral intervention in enuresis; behavioral therapy in encopresis; and family therapy in anorexia nervosa.

“The large body of literature reviewed here can inform future research aimed at addressing identified gaps, as well as current clinical care and guidelines regarding the choice of interventions for mental health conditions in youth, merging state-of-the-art efficacy and acceptability data with information on tolerability and safety,” Correll and colleagues wrote.