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Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Medication versus placebo, Outcome 1 Number relapsed.
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Analysis 1.1

Comparison 1 Medication versus placebo, Outcome 1 Number relapsed.

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Comparison 1 Medication versus placebo, Outcome 2 Suicide‐related behaviours.
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Analysis 1.2

Comparison 1 Medication versus placebo, Outcome 2 Suicide‐related behaviours.

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Comparison 1 Medication versus placebo, Outcome 3 Functioning (C‐GAS/GAF).
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Analysis 1.3

Comparison 1 Medication versus placebo, Outcome 3 Functioning (C‐GAS/GAF).

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Comparison 1 Medication versus placebo, Outcome 4 Depressive symptoms on clinician‐rated scale.
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Analysis 1.4

Comparison 1 Medication versus placebo, Outcome 4 Depressive symptoms on clinician‐rated scale.

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Comparison 1 Medication versus placebo, Outcome 5 Drop‐outs.
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Analysis 1.5

Comparison 1 Medication versus placebo, Outcome 5 Drop‐outs.

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Comparison 2 COMB (med + psych) versus med, Outcome 1 Number relapsed.
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Analysis 2.1

Comparison 2 COMB (med + psych) versus med, Outcome 1 Number relapsed.

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Comparison 2 COMB (med + psych) versus med, Outcome 2 Suicide‐related behaviours.
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Analysis 2.2

Comparison 2 COMB (med + psych) versus med, Outcome 2 Suicide‐related behaviours.

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Comparison 2 COMB (med + psych) versus med, Outcome 3 Functioning (C‐GAS).
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Analysis 2.3

Comparison 2 COMB (med + psych) versus med, Outcome 3 Functioning (C‐GAS).

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Comparison 2 COMB (med + psych) versus med, Outcome 4 Depressive symptoms on clinician‐rated scale.
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Analysis 2.4

Comparison 2 COMB (med + psych) versus med, Outcome 4 Depressive symptoms on clinician‐rated scale.

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Comparison 2 COMB (med + psych) versus med, Outcome 5 Drop‐outs.
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Analysis 2.5

Comparison 2 COMB (med + psych) versus med, Outcome 5 Drop‐outs.

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Summary of findings for the main comparison. Medication compared to placebo for preventing relapse and recurrence of a depressive disorder in children and adolescents

Medication compared to placebo for preventing relapse and recurrence of a depressive disorder in children and adolescents

Patient or population: patients with preventing relapse and recurrence of a depressive disorder in children and adolescents
Settings: outpatient
Intervention: medication
Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

Medication

Number relapsed‐recurred

667 per 1000

405 per 1000
(265 to 561)

OR 0.34
(0.18 to 0.64)

164
(3 studies)

⊕⊕⊕⊝
moderate2

Suicide‐related behaviours

12 per 1000

13 per 1000
(2 to 85)

OR 1.02
(0.14 to 7.39)

164
(3 studies)

⊕⊕⊝⊝
low2,3

Drop‐outs

259 per 1000

263 per 1000
(117 to 494)

OR 1.02
(0.38 to 2.79)

164
(3 studies)

⊕⊕⊕⊝
moderate3,4

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 For allocation concealment, three trials contained unclear risk of bias. In more than one trial there was insufficient evidence to rate blinding of participants and/or interviewers.
2 In all three trials there was 'unclear' risk of bias pertaining to allocation concealment, and in two trials there was insufficient information to deduce if assessors and participants were adequately blinded to treatment condition.
3 Total number of events is less than 300.
4 All trials adequately reported on number of drop‐outs and reasons.

Figuras y tablas -
Summary of findings for the main comparison. Medication compared to placebo for preventing relapse and recurrence of a depressive disorder in children and adolescents
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Comparison 1. Medication versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number relapsed Show forest plot

3

164

Odds Ratio (M‐H, Fixed, 95% CI)

0.34 [0.18, 0.64]

1.1 Re‐randomisation early

1

102

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.14, 0.73]

1.2 Re‐randomisation late

2

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.37 [0.13, 1.05]

2 Suicide‐related behaviours Show forest plot

3

164

Odds Ratio (M‐H, Fixed, 95% CI)

1.02 [0.14, 7.39]

2.1 Re‐randomisation early

1

102

Odds Ratio (M‐H, Fixed, 95% CI)

3.18 [0.13, 79.96]

2.2 Re‐randomisation late

2

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 8.26]

3 Functioning (C‐GAS/GAF) Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Continuation/maintenance treatment for responders only

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Depressive symptoms on clinician‐rated scale Show forest plot

3

164

Std. Mean Difference (IV, Random, 95% CI)

‐0.07 [‐0.68, 0.55]

4.1 Re‐randomisation early

1

102

Std. Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.86, ‐0.07]

4.2 Re‐randomisation late

2

62

Std. Mean Difference (IV, Random, 95% CI)

0.25 [‐0.31, 0.81]

5 Drop‐outs Show forest plot

3

164

Odds Ratio (M‐H, Random, 95% CI)

1.02 [0.38, 2.79]

5.1 Re‐randomisation early

1

102

Odds Ratio (M‐H, Random, 95% CI)

2.03 [0.73, 5.67]

5.2 Re‐randomisation late

2

62

Odds Ratio (M‐H, Random, 95% CI)

0.57 [0.18, 1.76]
Figuras y tablas -
Comparison 1. Medication versus placebo
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Comparison 2. COMB (med + psych) versus med

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number relapsed Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Suicide‐related behaviours Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Functioning (C‐GAS) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Depressive symptoms on clinician‐rated scale Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5 Drop‐outs Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 2. COMB (med + psych) versus med
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