Depression in Children and Teens
Medications
Medicines used to treat depression in children and teens are currently being researched for safety and long-term effects. You may have heard about concerns regarding a possible connection between antidepressant medications and suicidal behaviour. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories about this issue. Especially during the first few weeks of treatment with an antidepressant, there is a possible increase in suicidal feelings or behaviour. A child beginning antidepressant treatment should be monitored closely. But children with untreated depression are also at an increased risk for suicide, so it is important to carefully weigh all of the risks and benefits of antidepressant medicine.
Medication Choices
Medication choices include:
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, for example). Fluoxetine is currently the only SSRI approved for treating depression in children and teens. But other SSRIs such as citalopram (Celexa) or sertraline (Zoloft) may be effective and are sometimes prescribed.
- Atypical antidepressant medications, such as bupropion (Wellbutrin, for example) or venlafaxine (Effexor).
- Monoamine oxidase inhibitors (MAOIs), such as tranylcypromine (Parnate) or phenelzine (Nardil).
- Tricyclic antidepressants such as amitriptyline (such as Elavil) or desipramine. Tricyclic antidepressants have been used in the past for childhood depression, but recent studies have found limited evidence that these medicines are effective.16 Tricyclics also carry the risk of overdose and other serious consequences, such as heart problems.
What To Think About
While antidepressant medications such as fluoxetine (Prozac, for example) can be effective in treating depression, it may take 1 to 3 weeks before your child starts to feel better. It can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressant medicines as prescribed and keeps taking them so they have time to work. If you have any questions or concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child's doctor.
SSRIs may also be effective in treating other conditions such as anxiety.
Your child may have to try several medicines before the most effective treatment is discovered. After the right medicine is found, your child may need to continue taking the medicine for several months or longer after the symptoms of depression have subsided to prevent depression from occurring again.
Some children who are first diagnosed with depression are later diagnosed with bipolar disorder, which has symptoms that cycle from depression to mania (very high energy, often with euphoria, agitation, irritability, risk-taking behaviour, or impulsiveness). If your child or teen has bipolar disorder, a first episode of mania can happen spontaneously, but it can also be triggered by certain medicines such as stimulants or antidepressants. That is why it is very important to tell your child's health professional about any family history of bipolar disorder and to monitor your child closely for signs of manic behaviour. For more information about bipolar disorder in young people, see the topic Bipolar Disorder in Children and Teens.
Should my child take medications to treat depression?
Managing the side effects of antidepressants
Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued:
- Advisories on antidepressant medicines and the risk of suicide. Health Canada and the FDA do not recommend that people stop using these medicines, but to watch for warning signs of suicide in those using them. This is especially important at the beginning of treatment or when doses are changed.
- Warnings about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.
While medicines can be an effective treatment for children with depression, Health Canada and the FDA asked drug companies to include extensive packaging information warning about the danger of suicidal thoughts or actions during antidepressant use. Health Canada and the FDA encourage anyone considering the use of an antidepressant in a child or teen to balance the increased risk with the need to use the medicine. If your child is taking an antidepressant, do not stop its use suddenly. Talk to your health professional about any concerns you may have, and watch your child closely for any warning signs of suicide.
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| Author: | Jeannette Curtis Lila Havens Carrie Henley | Last Updated: June 26, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Michael J. Sexton, MD - Pediatrics Gisele Ferguson, MD, FRCPC - Psychiatry, Child and Youth Psychiatry | |
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