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Childhood Depression

Treatments for Childhood Depression

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Updated: October 16, 2007

Psychotherapy

Due to concerns about drug safety, parents often opt to try psychotherapy before resorting to medications. Psychotherapy can be helpful to children and may be all that is necessary to help them sort out their feelings and learn the skills they need to cope with life's stresses.

There are many theoretical approaches to psychotherapy, but probably the most effective in the treatment of childhood depression is cognitive-behavioral therapy. This type of therapy focuses upon the role of thinking and belief systems as the root of depression. People with depression have certain characteristic thought patterns, called cognitive distortions, which give them a skewed perception of the world around them. During cognitive-behavioral therapy, the psychologist works with the patient to help them recognize their dysfunctional thoughts and to change them to a more realistic perspective.

Other types of therapy that may be helpful with childhood depression include: interpersonal therapy, which focuses on interpersonal relationships and coping with conflict; family therapy, which focuses on the importance of family relationships in psychological health; and play therapy, which makes use of children's natural tendency to engage in play in order to help them work through their inner conflicts and anxieties.

Medications

The FDA requires that all antidepressant drugs be labeled with a boxed warning regarding the increased risk of suicidal thoughts and behaviors in children and adolescents. This risk was determined by taking data from 24 different antidepressant trials involving 4,400 patients. The analysis of this data showed that during the first few months of treatment the risk for suicidality was double that for those receiving only a placebo. No completed suicides occurred during the trials.

Does this mean that your child should avoid antidepressants? Not necessarily. Even though the risk of suicidal thoughts and feelings doubled, this figure was still only a small percentage of the patients who were taking the drug. While it does signal the need for caution, parents should keep in mind that untreated depression can also lead to suicidal feelings. The expert opinion at this point is that the benefits of antidepressants still outweigh the risks.

The only antidepressant that is currently approved for major depression in children is Prozac. Prozac, Zoloft, Luvox and Anafranil are approved for OCD in children. This does not necessarily mean that other drugs are less safe. It simply means that those drugs have not been adequately tested for pediatric use. Please note that even though these particular drugs are approved for use in children, they still contain the boxed warning. There is not enough data at this point to exclude any antidepressant from the warning.

The FDA offers the following recommendations to help your child use antidepressants safely:

  • Do not stop giving your child his medication without your physician's advice and supervision. Your child can experience discontinuation symptoms if his medication is stopped too quickly.
  • Work with your child's physician to weigh the increased risk of suicidality against the potential benefit for the child.
  • If you start your child on an antidepressant, it is critical that you be able to monitor him for any worsening of symptoms, agitation, irritability, suicidality or changes in behavior.
  • You should be able to stay in close contact with your healthcare provider about any changes in your child that you observe.
  • In addition to monitoring your child during the early phases of treatment, it is also necessary to monitor him during increases or decreases in his dose.
  • It is recommended that antidepressants and other medications be prescribed in the lowest quantity possible to avoid the possibility of overdose.

Which Is Best, Psychotherapy or Medication?

Depending on the severity of your child's depression and its causes, therapy alone, medication alone, or therapy combined with medications may be advised by your doctor. Generally speaking, a combination of both will get the best results. An antidepressant helps correct the chemical imbalance within the brain responsible for the symptoms of depression. After this imbalance is corrected, your child will begin to feel better. But, the negative thought patterns which lead to depression may still remain. Therapy will help him alter these thought patterns and better cope with stressors in his life that contribute to his depression.

Sources:

"Antidepressant Use in Children, Adolescents, and Adults." U. S. Food and Drug Administration. May 2, 2007. U. S. Food and Drug Administration. Accessed: October 15, 2007.

Behrman, Richard E., Robert M. Kliegman and Hal B. Jenson. Nelson Textbook of Pediatrics. Philadelphia : Elsevier Science, 2004.

Bridge, J. A. "Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials." Journal of the American Medical Association 297.15 (2007): 1683-96.

Compton, Scott N., et. al. "Cognitive-Behavioral Psychotherapy for Anxiety and Depressive Disorders in Children and Adolescents: An Evidence-Based Medicine Review." Journal of the American Academy of Child and Adolescent Psychiatry 43.8 (2004): 930-59.

Antidepressants Which Have the Boxed Warning

Anafranil (clomipramine HCl) Paxil (paroxetine HCl)
Aventyl (nortriptyline HCl) Pexeva (paroxetine mesylate)
Celexa (citalopram HBr) Prozac (fluoxetine HCl)
Cymbalta (duloxetine HCl) Remeron (mirtazapine)
Desyrel (trazodone HCl) Sarafem (fluoxetine HCl)
Effexor (venlafaxine HCl) Serzone (nefazodone HCl)
Elavil (amitriptyline HCl) Sinequan (doxepin HCl)
Lexapro (escitalopram oxalate) Surmontil (trimipramine)
Limbitrol (chlordiazepoxide/amitriptyline) Symbyax (olanzapine/fluoxetine)
Ludiomil (Maprotiline HCl) Tofranil (imipramine HCl)
Luvox (fluvoxamine maleate) Tofranil-PM (impiramine pamoate)
Marplan (isocarboxazid) Triavil (Perphenaine/Amitriptyline)
Nardil (phenelzine sulfate) Vivactil (protriptyline HCl)
Norpramin (desipramine HCl) Wellbutrin (bupropion HCl)
Pamelor (nortriptyline HCl) Zoloft (sertraline HCl)
Parnate (tranylcypromine sulfate) Zyban (bupropion HCl)
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  3. Depression
  4. Who's at Risk?
  5. Age Groups
  6. Child Depression
  7. Depression in Young Children
  8. Childhood Depression - Treatments for Childhood Depression

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