Measurement Matters in Evaluating Youth Antidepressant Effectiveness

Background: Antidepressants are widely used to treat adolescent depression, despite ongoing debates regarding their efficacy for youth. In this back and forth, surprisingly little attention has been paid to measurement issues. Though seemingly basic, careful consideration of measure selection and related assessment decisions is critical to evaluating antidepressants as a treatment option for adolescents. Objectives: The objectives of the current review are to 1) highlight the psychometric quality of commonly used assessment measures in randomized controlled trials (RCTs) and 2) discuss pertinent assessment issues that may impact conclusions drawn regarding antidepressant efficacy. These issues include consistency of findings across measures, selection of an index of symptom change, choice of symptom reporter, and time to assessment follow-up. Methods: This review discusses the quality of widely used assessment measures and highlights how findings from RCTs differ based on assessment decisions. Conclusion: Measures and measurement decisions impact conclusions drawn when evaluating antidepressant effectiveness. Even some of the most commonly used measures in RCTs have limited evidence for reliability and validity, calling into question findings derived from those measures. Additionally, antidepressants are inconsistently found to outperform placebo, with only a quarter of comparisons finding antidepressants to be statistically superior. Results are even less promising when looking at youth- or parent-report and longterm follow-ups. The review concludes by providing suggestions for improving assessment of antidepressant effectiveness for youth.