The Safety of Antidepressants in Childhood Depression

Depression in children is a serious condition that can cause changes in thinking, mood, and behavior. Until the 1970s, medical professionals thought the disorder occurred only in adults.

­Doctors struggled with ways of determining the difficult diagnosis until 1991 when the CDI, or child depression inventory, was developed.

A checklist of symptoms, the CDI is used to screen for two types of depression: dysthymic disorder and major depressive disorder. Still, children are less able than adults to express their feelings, and actions change quickly. Doctors usually observe behavior over a period of time and also consider reports from parents, teachers, and caregivers.

Children are often treated for depression with a combination of psychotherapy and antidepressants. Although there has been debate about the safety of these drugs, “The Journal of American Medical Association” printed results of a 2007 study that found antidepressants do more good than harm in adolescents with major depressive disorders. Children must be carefully watched, however, for signs of agitation, irritability, withdrawal, or self-destructive behavior.

The most commonly used antidepressants for children are serotonin reuptake inhibitors, or SSRIs. These drugs have fewer side effects than older ones, and overdoses are less likely. Although new medications are being developed, the following SSRIs are the most common:

• Prozac – fluoxetine

• Zoloft – sertraline

• Celexa – citalopram

• Paxil – paroxetine

• Luvox – fluvoxamine

• Lexapro – escitalopram

Effexor, or velaxafine, is closely related to serotonin reuptake inhibitors but actually falls into another category. The safety of its use for children is currently being investigated.

According to the National Institute of Mental Health, Prozac is the only antidepressant approved by the Federal Drug Association for treating children eight years of age or older. Other drugs that have been approved for adults are sometimes prescribed “off-label” for children and adolescents. Although Prozac has proven to be beneficial in reducing the overall symptoms of depression, there is also a small possibility that it may lead to suicidal thinking in a very few adolescents.

As with any medication, the use of antidepressants should be carefully monitored by medical professionals and parents, and any side effects or change in behavior should be reported immediately. Dosages should be administered as directed, and a doctor should be consulted before stopping any medication.

At least one major clinical trial found a combination of medication and psychotherapy to be the most effective treatment for adolescent depression. Nevertheless, more studies are needed to determine side effects of long-term use and the relationship between the drugs and childhood or adolescent suicide. Although evidence overwhelmingly supports the safety of SSRIs in most cases, there is still doubt about a small subset of the population.­

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