When thinking about treatment for your child's depression, you may have heard that antidepressants may increase the risk of suicidal thoughts and behaviors. Given this, deciding on the right treatment for your child can be scary. However, because of the serious short- and long-term consequences associated with depression, finding the right treatment is essential.
What Does Research Say About Antidepressants and Suicide?
The Food and Drug Administration (FDA) reviewed the research on children and selective serotonin reuptake inhibitors (SSRI) use. Although the numbers are small, they found about twice the rate of suicidal thoughts and behaviors in children using SSRI medication as compared to children using a placebo, or an inactive pill.
Given these findings, in 2004 the FDA issued a black box warning for an increased risk of suicidal thoughts and behavior in children and adolescents using SSRIs. This warning was then extended to adults through age 24 in 2006.
A black box warning does not remove a drug from the market, but instead issues a warning to prescribing physicians, pharmacists, and patients taking the medication.
In the case of SSRI medications, it is recommended that children be closely monitored in the initial phase of treatment and observed for worsening symptoms of depression, unusual changes in behavior, and/or and any indication of suicidal thoughts or behaviors..
Treatment Is Recommended for Childhood Depression
Despite the FDA's warnings, SSRI use is still common among depressed children and adolescents. Other known associated side effects, such as headache and nausea are known to be mild and short-lasting.
A comprehensive study supported by the National Institute on Health (NIH) which was published in 2007 determined that the benefits of SSRI use in children with major depressive disorder likely outweigh any risks.
Furthermore, depression itself is a risk factor for suicidal thoughts and behavior in children. When depression is left untreated, the risk of suicidal thoughts and behaviors increase. In fact, some research indicates that the earlier the onset of depression and the more recurrences that a child experiences, the more likely she is to experience suicidal thoughts and behaviors.
Prozac (fluoxetine) is currently the only approved SSRI for childhood depression, which means that the most research exists on this specific drug and its effects on children.
What Parents Can Do
Your concerns about antidepressant use in your child are valid and should be thoroughly addressed by your child's physician.
Depression in children always needs treatment. Have your child evaluated by a professional to determine the safest and most effective treatment for her case.
If your child has a history of suicidal thoughts or behavior, or if there is a family history of suicidal behaviors, be sure to tell your child's physician as this may play a role in her selected treatment.
Also, talk to your child about suicide. It will not give her ideas, but provide her with a forum to talk about her feelings.
Antidepressant Use in Children, Adolescents, and Adults. U.S. Food and Drug Administration. Accessed: May 28, 2010. http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273
March, J., Silva, S., Petrycki, S. et al. Fluoxetine, Cognitive-Behavioral Therapy, and Their Combination for Adolescents with Depression: Treatment for Adolescents With Depression Study (TADS) Randomized Controlled Trial. Journal of the American Medical Association. August 18, 2004. 292(7): 807-820.
National Institutes on Mental Health. Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers. Accessed: June 08, 2011. http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml
P. Hazell, D. O’Connell, D. Heathcote, D.A. Henry. "Tricyclic Drugs for Depression in Children and Adolescents." Database of Systematic Reviews. 2002(2).
Prozac Medication Guide. Eli Lilly and Company. Accessed: June 08, 2011.http://www.prozac.com/Pages/index.aspx