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Antidepressant Medications for Children and Adolescents

As many as 28% of adolescents admit to having experienced symptoms of depression within the past year—severe enough to impair their lives at home, in school, and within relationships. Depression is a serious disorder that can cause problems with mood, thinking and behavior. If severe enough and left untreated, it is associated with substance abuse and even suicidal thoughts and behaviors. In fact, suicide is the third-leading cause of death among children 15-24 years old.

But in spite of all that is known about treating depression in adults, there is relatively little information about how to successfully treat this disorder in children. Treatment with antidepressants called serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Paxil and Effexor has risen greatly over the past several years, but as many as 30% of children don’t respond to such medication therapy. Added to this frustration is the recent alarming warning from the Food and Drug Administration (FDA) that antidepressant medications used in the treatment of depression actually raise the suicide risk for some children and teens—as much as twofold or more. In October of 2004, the FDA directed all manufacturers of antidepressants to include a “black box” label warning, the most serious form of drug label warning, on these medications. This measure is intended to alert physicians and patients to the increased risk of suicidal thinking and behaviors in children taking these drugs.

What should you do if you suspect your child is depressed and could benefit from medical treatment?

• First, make certain that a physician who has training and expertise in the area of mental health evaluates the child. Diagnosing depression can be trickier in children and adolescents because symptoms may vary according to the child’s developmental stage. Additionally, young people may have more difficulty than adults in describing their feelings.

• Unless the depression is severe, consider several appointments of psychotherapy before agreeing to medication. Sometimes behavioral therapy is sufficient in treating the problem.

• If an antidepressant is recommended, find out as much as you can about the medication. Talk with the physician and your child about the risks and benefits of taking this drug. Be aware that of all antidepressants, only fluoxetine (Prozac) has been FDA approved to treat depression in children and adolescents.

• If you and your child do make a decision to try a medication, make a plan with the physician. The riskiest time for suicidal thoughts and behaviors during use of an antidepressant is in the first two weeks of treatment. The child should be seen weekly four the first four weeks to review possible side effects, then every other week for the next month, then monthly until stabilized.

• Be vigilant for changes in your child’s behavior, such as worsened depression, anxiety, suicidal thoughts, agitation, aggressive, angry or violent behaviors, difficulty sleeping, or acting hyperactive. Contact the prescribing physician right away if any of these occur.

Be aware that antidepressants should not be given in the absence of psychotherapy. In August of 2004, findings from a large study funded by the National Institute of Mental Health (NIMH) showed that a combination of medication and psychotherapy is most effective in treating depression in children.

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