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Antidepressants for Children

Antidepressant Black Box Warnings

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Updated October 11, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

In 2004, a black box warning label was added to antidepressant medications that are used to treat children, teenagers, and adults.

This warning states that antidepressants "increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents."

The warning also talks about balancing this risk of increased suicidality with the clinical need of taking an antidepressant, as well as the importance of observing children and teens for signs of worsening, suicidality, or unusual changes in behavior.

In 2007, the warning was expanded to include older teens and young adults between the ages of 18 to 24.

Antidepressants in Pediatrics

Unfortunately, after these warnings came out, many parents and pediatricians focused on the risk of suicidality and seemed to forget about the benefits of these medicines.

It is important to note that no one actually committed suicide in the studies that were used to come up with the warnings.

According to Mitchell Mathis, M.D., deputy director of the Division of Psychiatry Products at the Food and Drug Administration (FDA), "There weren't more actual suicides, but more people under 24 were thinking or talking about it." Mathis explains that "this occurs most often within the first 30 days of an adolescent or young adult starting on an antidepressant."

Rates of suicide did increase in the years after this warning came out, though, perhaps because fewer kids were taking antidepressants.

Also, depression itself is a risk factor for suicide.

And according to the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, "the rate of suicide among American youth ages 10-19 actually dropped by more than 25 percent" in the 1990s, a time when "there was a large increase in the number of adolescents being prescribed SSRI antidepressants."

Antidepressants for Children

Although a long list of antidepressants are available, from Anafranil (clomipramine) to Zyban (bupropion), few are approved for use in pediatrics.

In fact, only Prozac (fluoxetine) is FDA approved to treat children and teens with depression. Another antidepressant, Lexapro (escitalopram), is FDA approved to treat older children and teens between the ages of 12 and 17 with depression.

More antidepressants, including Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), and Anafranil (clomipramine), are approved to treat children and teens with obsessive compulsive disorder (OCD).

If your child is prescribed one of these antidepressants, be sure to watch for any signs that might show he was getting worse, such as:

  • thoughts about suicide or dying, or actually attempting suicide
  • new or worsening symptoms of depression or anxiety
  • panic attacks or feeling very agitated or restless
  • trouble sleeping
  • an increase in impulsiveness or hyperactivity
  • new or worsening irritability, aggression, or other changes in behavior or mood

Also, be sure to have close follow-up with your pediatrician, child psychiatrist, or other health care provider who prescribed your child's antidepressant, with visits once a week for the first four weeks, every two weeks for the next four weeks, and then again after three months.

Sources:

Bhatia Supriya K., et al. Antidepressant Prescribing Practices for the Treatment of Children and Adolescents. Journal of Child and Adolescent Psychopharmacology. February 2008, 18(1): 70-80.

CDC. Suicide Trends Among Youths and Young Adults Aged 10-24 Years - United States, 1990-2004.

FDA. Antidepressant Use in Children, Adolescents, and Adults. Updated May 2007. Accessed October 2011.

Gibbons RD. The relationship between antidepressant prescription rates and rate of early adolescent suicide. Am J Psychiatry. 01-NOV-2006; 163(11): 1898-904

Isacsson G. The increased use of antidepressants has contributed to the worldwide reduction in suicide rates. Br J Psychiatry. 01-JUN-2010; 196(6): 429-33

ParentsMedGuide. Medication Guide for Treating Depression. Accessed October 2011.

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