Antidepressants: Are they safe for your child or teen?
Though antidepressants are supposed to help make people feel better, sometimes — particularly in kids and teens — they can have the opposite effect.
To deal with such unintended consequences, back in 2004, the FDA began to require a warning on all antidepressants that some of these medications may increase the risk of suicidal thinking and behavior in children, teenagers, and younger adults — especially in the first months after starting treatment.
From the Myria editorial team
The current notice reads, in part, “Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.” (The FDA noted that scientific data did not show this increased risk in adults older than 24, and emphasized that depression and certain other serious psychiatric disorders are themselves the most important causes of suicide.)
More recent research has backed up these concerns, but has also provided more data to help caregivers prescribe these medications safely.
Dosage dos and don’ts
Matthew Miller, MD, ScD, of the Harvard School of Public Health in Boston, reported in 2014 that children and young adults who started SSRI antidepressant therapy at high doses, rather than the more typically-prescribed dosages, appeared to be at greater risk for suicidal behavior during the first 90 days of treatment.
In fact, the rate of suicidal behavior (deliberate self-harm) among people 24 years of age or younger was about twice as high compared with a matched group of patients who received generally-prescribed doses.
A Vanderbilt University Medical Center study released in 2014 showed there is no evidence that the risk of suicide differs with two antidepressants — serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) — commonly prescribed to children and adolescents.
Because antidepressants differ in their characteristics, including effects on neurotransmitters, it has also been believed that the risk of suicidal behavior for individual medications might differ.
The study noted that SSRIs, like fluoxetine, are the most widely-used antidepressants/anti-anxiety drugs, slowing down the rate at which serotonin, an important signaling molecule in the brain, is broken down. An SNRI, like Duloxetine, is a newer type of antidepressant that does the same thing for another important chemical, noradrenaline, as well as serotonin.
Some doctors don’t want to take a chance
With so many concerns, pediatric primary care practitioners (PCPs) have been found to be reluctant to prescribe antidepressant medications to adolescent patients — even those with severe depression, according to a 2014 study published in the Journal of Developmental & Behavioral Pediatrics.
Pediatricians who were more knowledgeable about depression — and especially those who had access to an on-site mental health care provider — were more likely to prescribe antidepressants for depressed teens. Most PCPs in the study said they would refer depressed adolescent patients to a child and adolescent psychiatrist for evaluation. Unfortunately, the number of teens with depressive symptoms far outweighs the treatment capacity of the child psychiatry work force.
Tips for safe antidepressant usage
Always pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is especially important when an antidepressant medicine is first started or when the dose is changed.
Call your doctor or healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings. You could also call your medical provider between visits as needed, especially if you have concerns about symptoms, or if you or your family member has any of the following symptoms — particularly if they are new, worse, or worry you:
thoughts about suicide or dying
attempts to commit suicide
new or worse depression, anxiety or irritability
feeling very agitated or restless
trouble sleeping (insomnia)
acting aggressive, being angry, or violent
acting on dangerous impulses
an extreme increase in activity and talking (mania)
other unusual changes in behavior or mood
One more note: Never stop taking an antidepressant medicine without first talking to your healthcare provider. There are specific ways to taper off so as to avoid withdrawal symptoms (aka discontinuation syndrome) and other potentially severe, unpleasant and possibly harmful side effects.
Pediatric age ranges & indications for antidepressant medications