Potential Prozac Side Effects in Children

Prozac (fluoxetine) is the only approved antidepressant for children ages 8 and older. As such, it is a commonly prescribed medication for children and teens with major depressive disorder and sometimes bipolar disorder.

Prozac is one of the most commonly prescribed selective serotonin reuptake inhibitor (SSRI) medications for adults and it has been shown to be the most effective one for kids. While it's not advised that Prozac is prescribed to every child, it can be part of a successful treatment plan for some individuals.

Before your child begins taking Prozac, it's important that you understand its potential side effects. Have a conversation with your child's doctor about these and be sure to monitor your child's behavior carefully if he does start taking it.

Prozac is generally well-tolerated in children, and few stop taking it because of bothersome side effects. The side effects of Prozac are often mild and short-lasting. If they occur, side effects usually happen at the start of treatment and often resolve within a few weeks without any need for additional intervention.

Common side effects may include:

• Gastrointestinal symptoms (e.g., nausea, upset stomach, diarrhea)
• Sleep changes (e.g., insomnia, somnolence, vivid dreams, nightmares, impaired sleep)
• Restlessness
• Sweating
• Headaches
• Restless legs
• Appetite changes (increase or decrease)
• Sedation

Additionally, a small percentage of children who take Prozac may show increased impulsivity, agitation, or irritability. These symptoms appear to be more likely in children with bipolar disorder, or those who are predisposed to develop it. Be sure to let your child's healthcare provider know if she has ever experienced a manic or hypomanic state, or if there is a family history of bipolar disorder.

Although rare, Prozac is associated with certain more serious side effects. If you notice any of the following in your child, contact your healthcare provider immediately:

• New or worsening anxiety or depression symptoms
• Severe agitation or restlessness
• Uncontrollable anger or violence
• Panic attacks (e.g., difficulty breathing, racing heartbeat)
• Symptoms of mania (e.g., racing thoughts, pressured and fast speech, excessive risk-taking)
• Unusual changes in behavior or mood
• Problems with coordination

Another serious side effect that warrants special attention is the risk of suicidal thoughts or behavior. The FDA has issued a public warning that this potential increases in children and adolescents up to age 25 who are taking SSRI antidepressant medications. The risk is highest when the medication is first taken and whenever the dose is changed.

Though it's important for everyone to be aware of suicidal ideation and self-harm signs in youth, it's even more imperative when children are taking an SSRI. Some of the warning signs include an increased sadness, isolation, panic attacks, or aggressiveness. These may be subtle and lead to thoughts about suicide or dying, suicide attempts, or self-injury.

According to reviews reported by the National Institute of Mental Health, the benefits of antidepressants most likely outweigh the risks for children and adolescents with major depression and anxiety disorders. A study published in The Lancet went further and compared various antidepressants. The conclusion states that, while these medications "do not seem to offer a clear advantage" for treating a child's depression, Prozac is likely the best option.

Like all medications, the decision to start treatment with a SSRI should carefully weigh the expected benefits and risks—including potential side effects—of the drug. While many side effects may resolve with time, a child should not suffer unnecessarily from additional complications. There are many depression treatment options that can help minimize the potential for these side effects.

Generally, it is still preferred that children with depression only use antidepressants as a last resort and therapy remains the first treatment option. Although most side effects of Prozac in children are usually mild and temporary, discuss all side effects, regardless of severity, with your child's clinician. As a team, you can work together to figure out the best treatment.