To quantify the trade-offs of alternative strategies in treating pediatric major depressive disorder with respect to the clinical benefit and risk of fatal and nonfatal suicidal behavior over a 5-year time horizon.
We developed a disease simulation model integrating epidemiological and clinical data from the literature to simulate the effect of selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and a combination of both on a US pediatric population with major depressive disorder.
In a cohort of 1,000,000 simulated individuals (ages 10–24 years), the use of SSRIs was associated with the highest number of suicide-related events, while CBT was associated with the lowest number. Over a 5-year period, the strategy with the highest number of symptom-free weeks depended on assumptions made regarding treatment efficacy beyond the available clinical data.
Considering the risk-benefit profile over a 5-year period, CBT offers a safer profile than combination treatment or SSRIs alone with respect to suicide deaths and attempts. Any additional benefits of SSRIs, either alone or in combination with CBT, must be weighed against the expected increase in suicides.