Some parents may be concerned about using antidepressants in children and teens. Certain antidepressants have an FDA issued black box warning on the label that cautions that the medicine may increase the risk of suicidal thinking and behavior in children, teens, and young adults. After further review, it was later determined to be overly cautious, and that the benefits of treating depression outweighed the small risk of increased risk of suicide. With awareness of the potential for an increase in suicidal thoughts, parents can be vigilant in working with mental health providers to ensure the safety of their children while effectively treating depression.
A specific group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) has been shown to help children and teens with depression, according to the National Institute of Mental Health (NIMH). The black box warning applies to these SSRIs, and suicidal thoughts or behavior are more likely in the first four weeks of use or when dosages are changed. Psychiatrists say the warning was meant, in part, to alert other doctors and parents to the need for closer monitoring.
Children and teens who begin taking SSRIs should be closely watched for any worsening of depression, suicidal thoughts or behavior, or any unusual changes in behavior, including sleeplessness, agitation or withdrawal from social situations.
Antidepressants don't work in every case. Prozac, for example, helps only about two-thirds of those who take it and some children experience side effects such as agitation.
Suicidal thoughts are very common in adolescents, fortunately many are not acted on,
Studies involving about 4,400 depressed kids led to the new warning. Those who took antidepressants were twice as likely to express suicidal thoughts as those who took placebos (sugar pills). The numbers were small—4 percent for those on the drugs versus 2 percent on placebos. There were no actual suicides.
If you think your child might have depression, don't worry about trying to define what it is, just get it checked out. See a mental health professional and get a comprehensive evaluation. The good news is that if it is depression, most kids can be helped.
Here are some suggestions from the NIMH:
Realize that depression in your child or teen is a serious condition that should be treated and monitored.
Your child should be thoroughly evaluated by a health care provider to determine if medication is appropriate. If an SSRI is prescribed, the child should be closely monitored, particularly during the first four weeks. And if suicidal thoughts or agitation develop, notify your provider at once.
Medications are not the only treatment for depression, but are usually required if the depression is more than mild. Many times psychotherapy is given as the first treatment for mild forms of depression. For more severe forms, medication may be given in combination with psychotherapy.
If your child expresses suicidal thoughts or behavior or even intimates these, or has nervousness, agitation, irritability, sleeplessness or easily changeable moods, have him/her evaluated without delay.
If your child is already taking an SSRI, he/she should not stop taking the medication without discussing it with a health care provider. The child also should continue to be monitored to see that the medication is helping.
Realize that any medication may have side effects. Talk to your health care provider if you have concerns about side effects.