Children and antidepressant medications

Over the past few years, parents have been overwhelmed with information about the effectiveness and safety of having children take antidepressant drugs. Some reports say that the drugs--especially the SSRIs, which are the only antidepressant medications approved for children--are the best medicine for debilitating melancholy. Others say that paradoxically, the drug may increase the risk of suicide in young people. This debate has been further complicated by an ongoing controversy about whether adults who take SSRIs have higher rates of suicide.

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After Food and Drug Administration hearings on the subject in February of 2004, the FDA told manufacturers of antidepressant medications to place black box warnings on the drug packaging saying that antidepressants can cause suicidal actions in children and adolescents. Recently, the FDA modified its warning, saying that the drugs "increased the risk of suicidal thinking and behavior in short-term studies of adolescents and children" with depression. Teenagers and young adults are at the highest risk for suicide. Each year, about 20 percent of adolescents contemplate suicide; by the end of high school, 1 in 10 has attempted it with almost 2,000 succeeding each year. About half of those who die suffer from major clinical depression.

So what are the options? Adolescent depression is a common, potentially lethal, and treatable disease. Recent studies of depression in adolescents have shown that the best treatment may be a combination of antidepressant medications and psychotherapy. While there is a risk in the use of antidepressants by adolescents, there is also a risk in doing nothing. Careful monitoring of the child's behavior during treatment is critically important. Getting in touch with the physician if there are any worrisome changes in a child's mood or behavior can do a great deal to prevent any tragic outcomes and ensure that the treatment will be successful.