by Linda Semlitz, MD
When and how is medication used when children and adolescents are diagnosed with depression?
If you are concerned that your child might be depressed, it is important to talk to your doctor. Any treatment should be based upon a solid diagnostic evaluation by a professional experienced in the care of mental health disorders in children and adolescents. About half of all children with depression may have other mental health disorders such as anxiety, ADHD, learning differences, or be at risk of abusing drugs or alcohol.
For youth with mild to moderate levels of depression, evidence-based -psychotherapy may be sufficient treatment. For youth with moderate to severe depression, medication is often considered as an addition to psychotherapy. An untreated single episode of depression can last 6-9 months, almost an entire school year.
About 55-65% of children and adolescents will respond to initial treatment with antidepressant medication. You may notice that your child’s medication is working if your child’s depressive symptoms (mood, interest, appetite, sleep, concentration, or suicidal thinking/behavior) improve or if they are functioning better at school, at home, or with peers. Your provider should collect information from you, the school, and your child through clinical assessments, self-reports, and questionnaires.
To date, fluoxetine, also known as Prozac, is the only antidepressant approved by the FDA for the treatment of depression in both children and adolescents ages 8 years and older. Escitalopram (also known as Lexapro) is approved for the treatment of depression in youth older than 12 years of age. Both medications are selective serotonin reuptake inhibitors or SSRSs. No other antidepressants have been approved by the FDA for the treatment of depression in youth. It can take up to 4 to 6 weeks of taking an SSRI regularly for the medication levels in the brain to be steady enough to decrease the symptoms of depression.
For the most part, SSRI medications are very well tolerated in youth. There are some risks and side effects. In 2004, the FDA issued a black box warning that antidepressant medication may increase the risk for suicidal thoughts or behaviors in a small percentage of youth. Others may develop hypomanic symptoms and behavioral activation. It is important for your child to have more frequent visits with their doctor at the onset of medication treatment. More frequent visits early in treatment will allow your child’s treatment provider to address any concerns about treatment response or side effects and to monitor your child for suicidal thinking and behavior.
If your child responds to medication, it is recommended that they continue taking the antidepressant for 6-12 months after remission. Any decision to stop medication should be made with your physician and closely monitored.
For an excellent review of psychiatric medications for children and teens, go to
https://www.aacap.org/App_Themes/AACAP/docs/resources_centers/resources/med_guides/
Linda Semlitz, MD is a recently retired American Academy of Child and Adolescent Psychiatrist who practiced internationally and locally