Depression In Children And Teens: Medications

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Medications

Medicines used to treat depression in children and teens are currently being researched for safety and long-term effects. You may have heard about concerns regarding a possible connection between antidepressant medications and suicidal behavior. The U.S. Food and Drug Administration (FDA) has issued advisories about this issue. Especially during the first few weeks of treatment with an antidepressant, there is a possible increase in suicidal feelings or behavior. A child beginning antidepressant treatment should be monitored closely. But children with untreated depression are also at an increased risk for suicide, so it is important to carefully weigh all of the risks and benefits of antidepressant medicine.

Medication Choices

Medication choices include:

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, for example). Fluoxetine is currently the only SSRI approved for treating depression in children and teens. But other SSRIs such as citalopram (Celexa) or sertraline (Zoloft) may be effective and are sometimes prescribed.
• Atypical antidepressant medications, such as bupropion (Wellbutrin, for example).
• Monoamine oxidase inhibitors (MAOIs), such as tranylcypromine (Parnate) or phenelzine (Nardil).
• Tricyclic antidepressants such as amitriptyline (such as Elavil) or desipramine (such as Norpramin). Tricyclic antidepressants have been used in the past for childhood depression, but recent studies have found limited evidence that these medicines are effective.¹⁵ Tricyclics also carry the risk of overdose and other serious consequences, such as heart problems.

What To Think About

While antidepressant medications such as fluoxetine (Prozac, for example) can be effective in treating depression, it may take 1 to 3 weeks before your child starts to feel better. It can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressant medicines as prescribed and keeps taking them so they have time to work. If you have any questions or concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child's doctor.

SSRIs may also be effective in treating other conditions such as anxiety.

Your child may have to try several medicines before the most effective treatment is discovered. After the right medicine is found, your child may need to continue taking the medicine for several months or longer after the symptoms of depression have subsided to prevent depression from occurring again.

Some children who are first diagnosed with depression are later diagnosed with bipolar disorder, which has symptoms that cycle from depression to mania (very high energy, often with euphoria, agitation, irritability, risk-taking behavior, or impulsiveness). If your child or teen has bipolar disorder, a first episode of mania can happen spontaneously, but it can also be triggered by certain medicines such as stimulants or antidepressants. That is why it is very important to tell your child's health professional about any family history of bipolar disorder and to monitor your child closely for signs of manic behavior. For more information about bipolar disorder in young people, see the topic Bipolar Disorder in Children and Teens.

Should my child take medications to treat depression?

Depression: Taking antidepressants safely

Depression: Dealing with medicine side effects

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines, but to watch for warning signs of suicide in those using them. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.

Last updated:	April 25, 2007
Author:	Lila Havens
Reviewed By:	Michael J. Sexton, MD - Pediatrics, Gisele Ferguson, MD, FRCPC - Psychiatry, Child and Youth Psychiatry
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC