Health Conditions

An estimated 2-10% of children and adolescents in the U.S. have depression. In light of this, it is important to try and find the best therapy for this younger population with the fewest side effects. However, in recent years, several antidepressant medications have been in the news due to reports of increased suicide risk among adolescent users. Because of these reports, beginning in 2004, the U.S. Food and Drug Administration (FDA) now requires manufacturers to add a black-box warning to the labeling of antidepressant medications to inform healthcare providers and the public of the increased risk of suicidal tendencies in adolescents who use antidepressants. This warning was extended by the FDA in May 2007 to include young adults aged 18-24 years who are just starting antidepressant therapy (usually the first 1-2 months of antidepressant therapy). A medication guide has also been developed to be distributed at the pharmacy with each new or refilled prescription for antidepressants. This doesn't mean that antidepressants shouldn't be used to treat younger depressed persons; however, more caution needs to be exercised to determine if the benefits of the antidepressant truly outweigh the potential risks.

Treatment Options

First-line treatment options for depression in adolescents include Cognitive Behavioral Therapy (CBT), interpersonal psychotherapy, antidepressants, psychosocial intervention, or a combination of the above. Non-drug options should be generally considered before starting a medication for depression.

The only antidepressant medication officially approved by the FDA for children 8 years of age or older is fluoxetine (brand name: Prozac). This generally should be the first medication considered. Other antidepressant options that are available but with less evidence to support their use in children and adolescents include sertraline (brand name: Zoloft) and paroxetine (brand name: Paxil).

If antidepressant medication is used in a child or adolescent, he or she should be monitored closely due to the potential increased risk for suicidality (thoughts or attempts of suicide). All pediatric patients being treated with antidepressants for any indication should be observed closely for clinical worsening of their depression, suicidality, and unusual changes in behavior, especially during the initial few months of therapy, or any time the antidepressant dose is changed. Monitoring should include at least weekly face-to-face contact with the child or adolescent or their family members or caregivers during the first 4 weeks of treatment, then every other week visits for the next 4 weeks, then at 12 weeks, and as clinically indicated beyond 12 weeks. Additional contact by telephone may be appropriate between face-to-face visits.

References

1. Paxil [package insert]. Research Triangle Park, NC: GlaxoSmithKline; July 2006, updated August 2007.
2. Dopheide JA. Recognizing and treating depression in children and adolescents. Am J Health-Syt Pharm. 2006;63(3):233-43.
3. Prozac [package insert]. Indianapolis, IN: Eli Lily Company; December 2006, updated March 2008.
4. Zoloft [package insert]. New York, NY: Pfizer Laboratories; September 2003, updated March 2008.
5. Kando JC, Wells BG, and Hayes PE. Depressive Disorders. Pharmacotherapy: a physiologic approach. 6th ed. Dipiro JT, Talbert RL, Yee GC, et al, eds. New York: McGraw-Hill, 2005: 1235-55.
6. U.S. Food and Drug Administration. FDA Issues Public Health Advisory on Cautions for Use of Antidepressants in Adults and Children. URL: http://www.fda.gov/bbs/topics/answers/2004/ANS01283.html. Accessed April 2007.
7. U.S. Food and Drug Administration. New Warnings Proposed for Antidepressants. URL: http://www.fda.gov/consumer/updates/antidepressants050307.html. Accessed March 26, 2008.
8. Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 2006; 63:332-9.

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Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.