This is certainly the most consequential paper published in child and adolescent psychiatry for the last few years. It shows that the meta-analyses that current child psychiatry guidelines rely on to recommend fluoxetine for depression were skewed by an unbelievable trial (n=40) in Iran which found an effect 15 times larger than the average. When this trial is removed all meta-analyses find the same as a recent Cochrane analysis which found 'small and unimportant differences.' The flawed meta-analyses by Zhou and @cipriani in the @TheLancet and Lancet Psychiatry need to be corrected. And guideline committees need to update their guidance in the context of the harms of these drugs including withdrawal effects, sexual effects and agitation/akathisia and suicidality in a minority of youths exposed to them. Link below