Should my child take medications to treat depression?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

There are many factors to consider when deciding whether your child should take medications to treat depression, including how severe the condition is, whether the child is taking medicines for other medical conditions, and how you and your child feel about taking medicine. Consider the following when making your decision:

• If your child's symptoms are mild, professional counseling and lifestyle changes without medicines may be all that is needed.
• If your child's condition gets worse or continues for longer than 8 to 12 weeks while your child is receiving professional counseling alone, medicines can be added to the treatment. Adding medicines to professional counseling for severe depression works better than counseling alone.
• Significant stress or changes in your child's life (such as divorce or death of a loved one) can trigger depression. It is difficult to tell the difference between temporary, normal feelings of sadness and depression. Click here to compare your child's symptoms of sadness or irritability with depression.
• Taking antidepressant medicines has both risks and benefits for your child. Risks include side effects and a possible increase in suicidal behavior. Benefits of effective treatment with medicines include reduced symptoms of depression and reduced problems related to depression.
• Depression is a medical condition, not a character flaw or weakness. Medicines may effectively treat the condition.
• Medicines will not alter your child's personality.

Medical Information

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What is depression?

Depression is a mood disorder that causes symptoms such as low energy, prolonged sadness or irritability, and lack of pleasure in daily activities. Depression is not the normal "moodiness" associated with maturing. It may be caused by an imbalance of brain chemicals (neurotransmitters). Depression runs in families. It may also be triggered by traumatic events in the child's life.

What are the risks of depression?

Often a child who is depressed will develop other disorders along with depression, such as an anxiety disorder, a behavior disorder like attention deficit hyperactivity disorder (ADHD), an eating disorder, or a learning disorder. These problems may occur before a young person becomes depressed. Some children with depression develop serious behavior problems (conduct disorder), usually after becoming depressed. If your child develops any of these disorders, it may require treatment along with treatment for depression.

A child or teen with depression is much more likely to use drugs, alcohol, or cigarettes. Approximately 30% of teens will develop alcohol or drug use problems along with depression.¹ This can make depression more difficult to treat, increase the length of time before treatment is successful, and increase the risk of suicide. Early diagnosis and treatment of depression along with good communication with your child can help prevent substance abuse. For more information about substance abuse in young people, see the topic Teen Alcohol and Drug Abuse.

Children and teens with depression are at a higher risk for developing other problems, such as:^{2 3}

• Poor school or job performance.
• Problems in relationships with peers and family members.
• Early pregnancy.
• Physical illness.

If your child has severe depression, he or she is at greater risk for suicide or attempted suicide. Some warning signs of suicide might include substance abuse problems or a preoccupation with death. Suicide attempts in children younger than age 12 are rare.

What medications are generally given to treat childhood and adolescent depression?

The U.S. Food and Drug Administration (FDA) has approved the use of fluoxetine (such as Prozac) in children and teens with depression. The FDA has not approved the use of other antidepressants in children, but they may be used.

If medicine is needed, fluoxetine or another selective serotonin reuptake inhibitor (SSRI) is usually the first type of antidepressant given. Possible side effects of SSRIs, such as nausea, loss of appetite, or diarrhea, are less severe than with other medicines. Other medicines may be tried if fluoxetine or another SSRI does not reduce your child's symptoms.

A combination of medication and professional counseling, such as cognitive-behavioral therapy, is usually most effective at reducing ongoing (chronic) or severe symptoms of depression.⁴

Are my child's symptoms due to depression or normal moodiness related to growing up?

All children experience some moodiness such as irritability or sadness as they are maturing into adults. While normal moodiness does not need treatment, depression does. Deciding whether your child's moodiness is normal or may be due to depression can be difficult. Learn how to recognize the difference between depression and normal moodiness in your child or teen.

If you need more information, see the topic Depression in Children and Teens.

Your Information

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Your child's choices are either to take medications to treat depression and continue with professional counseling or to continue with professional counseling alone.

The decision about whether to take medicines to treat childhood and teen depression takes into account your own and your child's personal feelings and the medical facts.

Deciding about medications for your child's depression

Reasons to take medicines

Reasons not to take medicines

Your child has not been able to overcome symptoms of depression with other treatment. You and your child are willing to work through any side effects that the medicines may cause and to continue taking medicines as prescribed. Your child's symptoms are worse than any potential side effects of the medicine. Your child has another condition that antidepressant medicine might help (such as obsessive-compulsive disorder). Are there other reasons you might want your child to take medicines?

The side effects of the medicines would be worse than minor symptoms of depression. Your child does not want to take medicines for a long period of time. Your child has been able to control symptoms of depression through professional counseling. Your child has tried a number of different medicines, and all of them cause intolerable side effects. Your child is taking medicines for other health conditions that will interfere with antidepressants. Are there other reasons you might not want your child to take medicines?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about your child taking medications to treat depression. Discuss the worksheet with your child's doctor.

Circle the answer that best applies to you.

Depression runs in our family.	Yes	No	Unsure
My child is willing to tolerate the side effects of medication.	Yes	No	Unsure
My child will attend professional counseling to help with depression.	Yes	No	Unsure
After reviewing information about normal moodiness versus depression, I think my child may have depression.	Yes	No	Unsure
My child has been depressed before.	Yes	No	Unsure
Professional counseling and lifestyle changes (such as exercising, getting enough sleep, and eating healthy) have not helped.	Yes	No	NA*
My child and I agree that my child's symptoms may be worse than the potential, temporary side effects of the medicine.	Yes	No	NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medications.

Check the box below that represents your overall impression about your decision.

Leaning toward taking medications

Leaning toward NOT taking medications

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.

Return to the topic Depression in Children and Teens.

References

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Citations

1. Renaud J, et al. (1999). A risk-benefit assessment of pharmacotherapies for clinical depression in children and adolescents. Drug Safety, 20(1): 59–75.

2. American Academy of Child and Adolescent Psychiatry (1998). Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 37(10): 63S–83S.

3. Rao U, et al. (1999). Factors associated with the development of substance use disorders in depressed adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 38(9): 1109–1117.

4. Brent DA, Birmaher B (2002). Adolescent depression. New England Journal of Medicine, 347(9): 667–671.

Credits

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Author	Jeannette Curtis
Author	Lila Havens
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Gisele Ferguson, MD, FRCPC - Psychiatry, Child and Youth Psychiatry
Last Updated	April 25, 2007