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Antidepressants for children: Explore the pros and cons
Learn why antidepressants have warnings about suicidal thinking in children, what to do before your child starts taking an antidepressant and warning signs of a potential problem.
By Mayo Clinic staffAntidepressant medications are often an effective way to treat depression and other mental disorders in children and adolescents. However, antidepressants do pose a risk of harmful side effects and complications. In fact, antidepressants are required to carry strong warnings about their possible link to suicidal behavior in children, adolescents and young adults ages 18 to 24.
You may be alarmed about the suicide warnings. But before you panic or refuse to allow your child to be treated with antidepressants, get the facts. Learn what the warnings mean, signs of trouble and other treatment options. This will help you make an informed decision about your child's health.
Why do antidepressants have warnings about suicidal behavior in children?
The Food and Drug Administration (FDA) says that an extensive analysis of clinical trials showed that antidepressants may cause or worsen suicidal thinking or behavior in children and adolescents. The analysis showed that children taking antidepressants had about a 4 percent chance of developing suicidal thoughts or behavior, compared with only a 2 percent chance in children 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 so disturbing that in October 2004 it issued a public health advisory and began requiring manufacturers to label antidepressants with strong warnings about the link to suicide in children.
However, not all mental health researchers believe these warnings are necessary. Some studies have reported opposite results — that suicide rates in children decrease when they take antidepressants.
Should children not be treated with antidepressants at all?
Not necessarily. The warnings about a possible link between antidepressants and suicidal thoughts don't mean that antidepressants can't 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 youngsters. For many children and adolescents, antidepressants are an effective way to treat depression, obsessive-compulsive disorder or other mental health conditions. If these conditions aren't treated effectively, your child may not be able to lead a happy, fulfilled life or engage in normal, everyday activities. In addition, suicide is a possible complication of depression if it isn't treated.
Which antidepressants must have the warnings about suicide?
Although the FDA analysis examined only nine antidepressants, the agency's concern was great enough to extend the warning to all prescription antidepressants. This warning is known as a "black box" warning. This is 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. Antidepressants will also come with a medication guide that advises parents and caregivers about risks and precautions.
What should you do before your child starts taking an antidepressant?
It's important that your child have a thorough evaluation before he or she starts taking an antidepressant. This evaluation should include:
- A physical exam
- A psychiatric exam by a psychiatrist, pediatrician or family doctor
The psychiatric evaluation should include:
- A detailed review of any potential risk factors your child may have that may make it more likely for him or her to engage in self-harm
- An assessment of whether your child may have other mental illnesses such as anxiety disorders, attention-deficit/hyperactivity disorder and bipolar disorder
- An evaluation of whether there's a family history of mental illnesses or suicide
What antidepressants can children take?
Fluoxetine FDA approved
Your child's doctor or qualified mental health professional can prescribe any antidepressant on the market. However, the FDA has officially approved only one antidepressant for the treatment of depression in children — fluoxetine (Prozac).
Off-label options
Doctors can use their medical judgment to prescribe other antidepressants for children. This practice, called off-label use, is a common, and perfectly legal, practice for many types of medications for both children and adults. Fluoxetine is also FDA approved to treat obsessive-compulsive disorder (OCD) in children, as are the antidepressants sertraline (Zoloft), fluvoxamine (Luvox) and clomipramine (Anafranil). Clinical trials of other antidepressants in children with depression, OCD or other disorders have failed to prove that they're significantly more beneficial than a placebo, so they haven't been officially approved for use in children.
(1 of 2)
- Moreland CS, et al. Effect of antidepressants on suicide risk in children and adolescents. http://www.uptodate.com/home/index.html. Accessed Aug. 29, 2008.
- 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.
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