Should Children Take Antidepressants?

There are multiple options for depression treatment, but the choice you make for your child's treatment can feel particularly important.

While research shows antidepressants are frequently effective in treating major depression and anxiety in children and teens, it's essential to understand the pros and cons and how they work in younger bodies. This article will help you discern whether or not antidepressants are right for your child.

What to Do if Your Child Is Anxious or Depressed

Before your child starts on an antidepressant, their doctor will want to conduct a physical exam and take their medical history to rule out any medical condition that may be causing their symptoms.

If these exams turn out fine, your child may then be referred to a mental health professional for a formal evaluation. This evaluation will gather important information such as family history, behaviors you notice in your child, and any risk factors there might be for them to hurt themselves.

Understanding all of these factors will help you and your mental health professional decide on the best course of action for your child, which may or may not include antidepressants.

Getting Your Child Started on Antidepressants

If you and your physician decide that an antidepressant is necessary, your child will start on the lowest possible dose. This may have to be adjusted if it's not helping your child's symptoms.

The risk for suicidal thoughts and/or behavior is greatest during the first couple months of starting an antidepressant, as well as if the dose is increased or decreased, so be particularly observant of your child's behavior during these times. Your mental health professional will also want to monitor your child fairly closely as well. 

Antidepressants Approved for Children

Of the five major classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the most commonly prescribed medication for children and adolescents with anxiety and depression.

Antidepressants for Depression

Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line medication option for young people with depression.

Prozac (fluoxetine) is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in both children and adolescents (ages 8 years and older); Lexapro (escitalopram) is approved to treat adolescents (ages 12 years and older) with depression.

No other antidepressants have been approved by the FDA for the treatment of depression in children and adolescents. However, your child's doctor may prescribe other antidepressant medications that are approved for use in adults. This is referred to as off-label use and it is fairly common practice.

Antidepressants for Anxiety

Three SSRIs have FDA-approval for use in children and adolescents with obsessive-compulsive disorder (OCD). While these SSRIs are approved by the FDA to treat OCD in children, they are not approved for pediatric non-OCD anxiety.

• Luvox (fluvoxamine): Approved for children age 8 and older
• Prozac (fluoxetine): Approved for children age 8 and older
• Zoloft (sertraline): Approved for children age 6 and older

Two non-SSRI antidepressants are approved by the FDA for treating generalized anxiety disorder in children (ages 7 and older): One SNRI, Cymbalta (duloxetine), and one atypical antidepressant, Anafranil (clomipramine).

Serious Side Effects

The most serious potential side effect of antidepressant use in people up to age 25 is their potential to increase the risk of suicidal thoughts and behaviors. Though this side effect is rare, in 2004, the FDA issued a black box warning about an increased risk of suicidal thoughts and/or behaviors in youth who take antidepressants.

If left untreated, depression can lead to a host of serious consequences, including attempted and completed suicide, addiction, and self-injury. This is why it is important to weigh the pros and cons of antidepressants. If your child has moderate to severe depression, the benefit of using an antidepressant will usually outweigh the risks of potential side effects.

Signs of Suicidal Thoughts in Children

Warning signs of suicidal thoughts may not be very obvious, which is why you need to watch your child closely when she first starts on an antidepressant or whenever her dosage is changed. Warning signs may include:

• Aggressive or hostile behavior
• Anxiety or restlessness
• A change in personality (from upbeat to quiet)
• Expressions of hopelessness about the future (e.g., "You won't have to worry about me anymore")
• Feelings of worthlessness, shame, guilt, or self-hatred
• Frequent statements or social media posts about self-harm or suicide (e.g., "I wish I were dead")
• Giving away belongings
• Neglecting personal appearance
• Preoccupation with death in conversation, writing, or drawing
• Risk-taking behavior (e.g., substance use, reckless driving, and sexual promiscuity)
• Running away from home
• Sleep, appetite, or energy changes
• Withdrawal from friends and family

If you see any of these signs in your child, particularly if they are new or noticeably worse than before, be sure to talk to your doctor as soon as possible.

Conclusion

In general, antidepressants are safe and effective to treat depression and anxiety in children and teenagers, especially when combined with psychotherapy. Also, keep in mind that antidepressant use is often temporary and may just be needed for a short time. If your child has mild depression, psychotherapy may be all they need to help their symptoms improve.

However, if the depression is severe or not responding to psychotherapy, an antidepressant may be needed to help your child live the best and most fulfilling life they can. If you have concerns and questions, be sure to discuss them with a mental health professional.