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Antidepressants for children: Explore the pros and cons
How many antidepressant pills should be prescribed at one time?
The FDA advises that prescriptions be provided for the smallest quantity of pills possible. This may help reduce the risk of deliberate or accidental overdose by controlling how many pills your child has access to. This may mean you have to get prescriptions refilled more frequently, but that minor inconvenience can provide added safety for your child. When you get the prescription, be sure to carefully read the medication guide and package insert, and discuss any questions with your child's health care professionals.
What should you do once your child starts taking an antidepressant?
Careful monitoring by parents, caregivers and health care professionals is important for any child or adolescent taking an antidepressant for depression or any other condition. The FDA recommends that your child see his or her health care professional on this schedule:
- Once a week during the first month of treatment
- Every two weeks during the second month of treatment
- A follow-up visit after 12 weeks of treatment
- As recommended after those first 12 weeks
Individual situations vary. Some youngsters may require more frequent or less frequent contact with their doctors or mental health professionals. Make sure you stick to your child's recommended schedule.
What warning signs should you watch for when your child is taking antidepressants?
Sometimes the signs and symptoms of suicidal thoughts or self-harm are difficult to see. They're not always obvious, and your child may not directly tell you that he or she is having such thoughts. Here are some signs and symptoms that your child's condition may be worsening or that he or she may be at risk of self-harm:
- Thoughts about suicide or dying
- Attempts to commit suicide
- Self-injury
- Feeling very agitated or restless
- Panic attacks
- Sleeping problems
- Increasing sadness
- An extreme increase in talking or activity
- Aggression, violence or hostility
- New or worsening anxiety
- Social or academic problems at school
- Spending more time alone
Contact your child's health care professional right away if any of these signs and symptoms occur, if they get worse, or if they worry you, your child, a teacher or other caregiver.
When is the risk of suicide or self-harm at the highest while taking antidepressants?
The highest risk of suicidal thinking and behavior occurs:
- During the first few months of treatment with an antidepressant
- When the dosage is increased or decreased
Parents and caregivers should closely observe children on a daily basis during these transition periods. Remain observant for worrisome changes for the whole time your child takes antidepressants. But don't stop antidepressant treatment without the guidance of your child's health care professional. Suddenly stopping an antidepressant may cause serious withdrawal-type symptoms.
How can medication meant to help treat depression and other illnesses lead to suicidal behavior in children?
Researchers speculate about a variety of potential reasons. In some cases, children may have bipolar disorder. Treating these children with antidepressants could cause an episode of mania — extreme emotional highs — that leads to risky, impulsive behavior and possibly self-harm. Antidepressants may also trigger anxiety, agitation, hostility, restlessness and impulsivity. These effects may occur if the child's depression gets worse, or they could indicate that your child is starting to develop suicidal thoughts.
What are the alternatives to treatment with an antidepressant?
If you're not comfortable with your child taking antidepressants or your child has had a bad reaction to antidepressants, talk to your child's doctor or mental health professional about other treatment options. For instance, a variety of counseling techniques are available, including:
- Psychotherapy
- Cognitive behavior therapy
- Family therapy
Family therapy may be helpful in some cases, to involve the whole family in psychotherapy.
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- FDA public health advisory: Suicidality in children and adolescents being treated with antidepressant medications — October 15, 2004. U.S. Food and Drug Administration. http://www.fda.gov/Cder/drug/antidepressants/SSRIPHA200410.htm. Accessed Sept. 18, 2008.
- FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. U.S. Food and Drug Administration. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html. Accessed Sept. 18, 2008.
- GLAD-PC Steering Group. Guidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management. Pediatrics. 2007;120(5):e1313-e1326. http://pediatrics.aappublications.org/cgi/content/full/120/5/e1313. Accessed Aug. 29, 2008.
- GLAD-PC Steering Group. Guidelines for adolescent depression in primary care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics. 2007;120(5):e1299-e1312. http://pediatrics.aappublications.org/cgi/content/full/120/5/e1299. Accessed Sept. 18, 2008.
- Moreland CS, et al. Psychopharmacological treatment for adolescent depression. http://www.uptodate.com/home/index.html. Accessed Aug. 29, 2008.
- Guirguis-Blake J, et al. Clinical inquiries. Which drugs are most effective for moderate to severe depression in adolescents? The Journal of Family Practice. 2008; 57(5):330-332.
- Labeling change request letter for antidepressant medications. U.S. Food and Drug Administration. http://www.fda.gov/cder/drug/antidepressants/SSRIlabelChange.htm. Accessed Sept. 18, 2008.
- FDA proposed medication guide: About using antidepressants in children or teenagers. U.S. Food and Drug Administration. http://www.fda.gov/cder/drug/antidepressants/SSRIMedicationGuide.htm. Accessed Sept. 18, 2008.
- Medication guide antidepressant medicines, depression and other serious mental illnesses, and suicidal thoughts or actions. U.S. Food and Drug Administration. http://www.fda.gov/cder/drug/antidepressants/antidepressants_MG_2007.pdf. Accessed Sept. 18, 2008.
- Bonin L, et al. Overview of treatment for adolescent depression. http://www.uptodate.com/home/index.html. Accessed Sept. 18, 2008.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 6, 2008.
