Antidepressants in Children

The FDA has approved only one drug for treating depression in children eight years of age and older: fluoxetine (Prozac). However, healthcare providers sometimes prescribe other drugs "off-label" for treating childhood depression. These other drugs can include SSRIs like sertraline, escitalopram, and citalopram; and SNRIs such as venlafaxine and duloxetine. More studies on children and antidepressants are needed in order to find out the appropriate dosages, how these drugs work in children, and any possible effects on learning and development.

An Overview of Antidepressants in Children

Depression is a serious disorder that can cause significant problems in mood, thinking, and behavior at home, in school, and with peers. It is estimated that clinical depression (also known as major depression) affects about 5 percent of adolescents.
 
Depression research has shown that, as in adults, depression in children and adolescents is treatable. Treatment options often include psychotherapy ("talk" therapy) and/or medications (known as antidepressants).
 
Certain antidepressant medications, called selective serotonin reuptake inhibitors (SSRIs), can be beneficial to children and adolescents with depression. However, our knowledge of how children respond to antidepressants, though growing substantially, is limited compared to what we know about treating depression in adults.
 

Understanding Antidepressant Medications

There are several classes of antidepressants used for treating depression. The antidepressant medicines most often used for children belong to two classes of drugs known as SSRIs and SNRIs.
 
Some of the SSRIs include:
 
Serotonin norepinephrine reuptake inhibitors (SNRIs) are not SSRIs but are closely related. Venlafaxine (Effexor®, Effexor XR®) and duloxetine (Cymbalta®) are two examples of SNRIs.
 
SSRI and SNRI medications are considered an improvement over older antidepressant medications because they have fewer side effects and are less likely to be harmful if taken in an overdose. They have been shown to be safe and effective for adults. However, the use of SSRI and SNRI medications among children and adolescents ages 8 to 19 has risen dramatically in the past several years.
 
Fluoxetine (Prozac) is the only medication approved by the U.S. Food and Drug Administration (FDA) for use in treating depression in children ages eight and older. The other SSRI and SNRI medications have not been approved for treatment of depression in children or adolescents, but doctors still sometimes prescribe them to children on an "off-label" basis. In June 2003, however, the FDA recommended that paroxetine not be used in children and adolescents for treating depression.
 
Fluoxetine can be helpful in treating childhood depression, and can lead to significant improvement of depression overall. However, it may increase the risk of suicidal behaviors in a small subset of adolescents. As with all medical decisions, doctors and families should weigh the risks and benefits of treatment for each individual patient.
 
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Depression in Children

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