Mills JA, et al. – Via performing a Bayesian hierarchical modeling meta-analysis of double-blind, placebo-controlled trials of pediatric patients with OCD and anxiety disorders treated with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), researchers compared antidepressant-related adverse events (AEs), suicidality, and AE-related discontinuation in this population. They included data from 18 trials (2,631 patients) and 7 medications (16 SSRI and 4 SNRI trials). Relative to placebo, SSRIs correlated more frequently with activation, sedation, insomnia, abdominal pain, and headache, and greater AE-related discontinuation in pediatric OCD and anxiety disorders. However, there were no differences in their tolerability between anxiety disorders and OCD. SSRIs vs SNRIs more frequently produced activation. The investigators suggested that clinicians should acknowledge class-related AEs, particularly in light of data implying differences in class-related efficacy. While for anxiety, SSRIs relative to SNRIs are superior and the treatment of choice, SNRIs might represent a good second choice for youth who become activated on SSRIs, given their reported efficacy and lower risk of activation.