A metareview of adverse effects of 80 psychotropic drugs in children and adolescents finds five drugs that appear to have the best safety profile — and also nominates those with the poorest safety.

In what is claimed to be the largest and most comprehensive evidence synthesis on the topic, international researchers scoured the literature on four major drug classes — antidepressants, antipsychotics, drugs for ADHD and mood stabilisers — looking for reports of 78 prespecifed adverse events.

They concluded that escitalopram and fluoxetine were antidepressants with the best safety profile, lurasidone was the safest antipsychotic, methylphenidate the safest drug for ADHD and lithium the safest mood stabiliser.

Their analysis included data from more than 337,000 children and adolescents, taken from nine network meta-analyses, 39 meta-analyses, 90 randomised controlled trials and eight cohort studies reporting adverse events.