Should Children Take Antidepressants?

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While antidepressants have been shown to be effective in treating major depression and anxiety in children and teens, they need to be used cautiously and monitored closely to make sure there are no serious side effects.

Antidepressants Can Cause Suicidal Thoughts and/or Behavior in Children

The most serious, and the most well-known, potential side effect of antidepressant use in people under 25 is that they can cause or worsen suicidal thoughts and/or behavior. This side effect is rare and only occurs in small numbers of children and teens, but it's serious enough that the Food and Drug Administration (FDA) has put a warning about it on every prescription antidepressant. Also, dealing with depression in and of itself can cause suicidal thoughts and/or behavior, which is yet another reason antidepressants should be considered carefully for moderate to severe depression with the help of your doctor. The benefits of using antidepressants usually outweigh the potential problems as they can be extremely helpful in an uplifting mood and lessening anxiety.

What to Do If Your Child Is Anxious or Depressed

Before your child starts on an antidepressant, it's best to have a complete physical examination to rule out any physical causes of depression or anxiety. If the physical exam turns out fine, the next step is to have a psychiatric evaluation done by a pediatrician, family doctor, psychiatrist or psychologist, preferably one who specializes in pediatric mental health. This evaluation will include important information such as family history, behaviors you notice in your child and any risk factors there might be for him to hurt himself. Understanding all of these issues 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.

Antidepressants Approved for Children

There are two antidepressants that the FDA has approved for use in children or teens to treat depression: Prozac (fluoxetine) for kids 8 and older and Lexapro (escitalopram) for kids 12 and older. Additionally, Zoloft (sertraline), Luvox (fluvoxamine) and Anafranil (clomipramine) have been approved along with Prozac to treat kids with obsessive-compulsive disorder (OCD).

Just because a medication is not FDA-approved doesn't mean that your doctor won't prescribe it, however, particularly if you have an older child. Physicians often prescribe other antidepressants for children and teens that are not FDA-approved because they have been proven to be effective and fairly safe. Be sure to read the medication guide that comes with your child's antidepressant to find out more information, such as risks, side effects, and cautions.

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, to begin with. 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 likely want to monitor your child fairly closely at first as well. 

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:

  • Becoming increasingly sadder
  • Panic attacks
  • Talking about dying
  • Becoming anxious or more anxious than before
  • Being restless and agitated
  • Developing problems at school or with friends or siblings
  • Increasing isolation
  • Trying to hurt himself
  • Noticeably talking or moving around more
  • Becoming violent, aggressive, or mean

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.

The Bottom Line 

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 she needs to help her 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 that he can. If you have concerns and questions, be sure to discuss them with a mental health professional.

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Article Sources

  • "Antidepressants for Children and Teens." Mayo Clinic (2013).