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Antidepressants for children and teens

Learn why antidepressants have warnings about suicidal thinking in children and teens, what to do before your child starts taking an antidepressant, and the warning signs of a potential problem.

By Mayo Clinic staff

Managing Depression

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Antidepressant medications are often an effective way to treat depression and anxiety in children and teenagers. However, antidepressant use in children and adolescents must be monitored carefully, as rarely there can be severe side effects. In fact, antidepressants carry a Food and Drug Administration (FDA) black box warning regarding a possible risk of increased suicidal behavior in some individuals under the age of 25.

Although at first you may find the suicide warnings alarming, it's important to get the facts. Find out what the warnings mean and ask about all treatment options. This will help you make an informed decision about your child's health and weigh the benefits and risks of treatment options with your child's doctor.

Why do antidepressants have warnings about suicidal behavior in children?

The FDA reported that an extensive analysis of clinical trials showed that antidepressants may cause or worsen suicidal thinking or behavior in a small number of children and adolescents. The analysis showed that 4 percent of those taking antidepressants had an increase in suicidal thoughts, compared with 2 percent of those taking a sugar pill (placebo).

None of the children in any of the studies actually took his or her own life. Still, the FDA considered the findings of enough concern that it issued a public health advisory and began requiring manufacturers to label antidepressants with strong warnings about the link to suicidal thinking and behavior in children, adolescents and young adults ages 18 through 24.

However, not all mental health researchers believe these warnings are necessary. Newer research indicates that the benefits of antidepressants may be greater than the risk of suicide. And some research indicates that suicide rates in children decrease when they take antidepressants.

Which antidepressants must have the warnings about suicide?

Although the FDA analysis examined only nine antidepressants, the FDA extended the warning to all prescription antidepressants. This is known as a black box warning — the strongest safety warning that the FDA can issue about a prescription medication. The warning is printed in bold type framed in a black border at the top of the paper inserts that come with antidepressants.

How can medication meant to help treat depression and other illnesses lead to suicidal behavior in children?

Because of the risk of suicide from depression, it's difficult to establish a clear causal relationship between antidepressant use and suicide. Researchers speculate about a variety of potential reasons for an increased risk. In some children, antidepressants may also trigger anxiety, agitation, hostility, restlessness or impulsive behavior. These effects may indicate that the child's depression is getting worse or that the child is starting to develop suicidal thoughts.

Should children not be treated with antidepressants at all?

The warnings about a possible link between antidepressants and suicidal thoughts do not mean that antidepressants should not be used to treat children. Nor are the warnings meant to frighten people away from antidepressants. However, the antidepressant warnings should be taken as a caution to carefully weigh the pros and cons of using these medications in children and teenagers against the real risk of suicide as a result of untreated depression.

For many children and teens, antidepressants are an effective way to treat depression, anxiety, obsessive-compulsive disorder or other mental health conditions. If these conditions aren't treated effectively, your child may not be able to lead a satisfying, fulfilled life or do normal, everyday activities.

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References
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  3. Chole CJ, et al. Depression. Child and Adolescent Psychiatric Clinics of North America. 2012;21:807.
  4. Adegbite-Adeniyi C, et al. An update on antidepressant use and suicidality in pediatric depression. Expert Opinion on Pharmacotherapy. 2012;13;2119.
  5. Antidepressant medications for children and adolescents: Information for parents and caregivers. The National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml. Accessed April 9, 2013.
  6. Clark MS, et al. Treatment of childhood and adolescent depression. American Family Physician. www.aafp.org/afp. Accessed April 9, 2013.
  7. Antidepressants in children, adolescents, and adults. U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Accessed April 9, 2013.
  8. Revisions to product labeling. U.S. Food and Drug Administration. http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM173233.pdf. Accessed April 9, 2013.
  9. Moreland CS, et al. Effect of antidepressants on suicide risk in children and adolescents. http://www.uptodate.com/home. Accessed April 14, 2013.
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MH00059 May 21, 2013

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