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Page 1 of 2 Read about the benefits and risks of antidepressant use in children and adolescents, along with research on the safety of antidepressants in children.
Should Your Child or Teenager Be Taking Antidepressant Medications?
Depression is a serious psychiatric condition that can cause significant problems in mood, thinking, and behavior at home, in school, and with peers. It is estimated that 5 percent of adolescents have major depressive disorder (MDD).
Research has shown that depression in children and adolescents is treatable. Certain antidepressant medications, called selective serotonin reuptake inhibitors (SSRIs), can be beneficial to children and adolescents with major depressive disorder. However, it's important to know that clinical trials of antidepressant treatments in children and adolescents is limited when compared to what is known about treating depression (using antidepressants) in adults. Parents should also know that certain types of psychological therapies also have been shown to be effective in treating depression in children and adults.
Antidepressant Use and the Risk of Suicidal Thoughts and Behaviors
Following a thorough review of all clinical trials, in 2004, the FDA issued a strong warning that antidepressants can increase suicidal thoughts and behaviors in some children and adolescents (2-3% of children taking antidepressants, according to the FDA). In 2006, that warning was extended to young adults up to the age of 25.
Warning On All Antidepressant Medication Labels
Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Antidepressants increased the risk of suicidality (suicidal thinking and behavior) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of antidepressants in children, adolescents or young adults must balance the risk to clinical need. Patients of all ages started on antidepressant therapy should be closely monitored and observed for clinical worsening, suicidality or unusual changes in behavior, especially at the beginning of therapy or at the time of dose changes. This risk may persist until significant remission occurs. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Lexapro is not approved for use in pediatric patients.
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Antidepressant Medication is Helpful in Treating Major Depression in Children and Teens
More recently, results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders. The study, partially funded by NIMH, was published in the April 18, 2007, issue of the Journal of the American Medical Association.
In the FDA review, no completed suicides occurred among nearly 2,200 children treated with SSRI medications. However, about 4 percent of those taking SSRI medications experienced suicidal thinking or behavior, including actual suicide attempts—twice the rate of those taking placebo, or sugar pills.
In response, the FDA adopted a "black box" label warning indicating that antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents with MDD. A black-box warning is the most serious type of warning in prescription drug labeling.
The warning also notes that children and adolescents taking SSRI medications should be closely monitored for any worsening in depression, emergence of suicidal thinking or behavior, or unusual changes in behavior, such as sleeplessness, agitation, or withdrawal from normal social situations. Close monitoring is especially important during the first four weeks of treatment. SSRI medications usually have few side effects in children and adolescents, but for unknown reasons, they may trigger agitation and abnormal behavior in certain individuals.
continue: How Should Your Child's Depression Be Treated?
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