Using Medication to Treat Depression in Children

What Parents Should Know About Depression in Children

child with pills in hand
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When your child is diagnosed with depression, it can be a frightening time for the whole family. Deciding whether to start your child on medication to manage depression can be additionally confusing. However, with serious short- and long-term consequences of depression--like poor social development, substance abuse, poor academic performance and suicidal thoughts and behavior--it is important to find a safe and effective treatment for your child.

Knowing the risks and benefits of medications and what to watch out for can help you make a confident decision for your child.

The Importance of Treating Depression in Children

According the American Academy of Pediatrics (AAP), 3% of all children are diagnosed with depression. The majority of children receiving treatment experience a decrease in their symptoms within two months. It is recommended that children receive prompt treatment because of the potential for serious consequences of untreated depression.

Is Medication Right for Your Child?

The type and severity of your child's depression plays a role in whether or not medication is appropriate.

For bipolar depression disorder and moderate to severe major depressive disorder (MDD), medication is typically indicated, as is recommended by the American Academy of Pediatrics. For milder cases of depression, likeĀ grief reactions due to loss or a stressful life event, counseling and family support may be sufficient.

In a study published in 2007, supported by The National Institute of Mental Health (NIMH), fluoxetine--best known as Prozac--combined with cognitive behavioral therapy (CBT) showed an improvement in depressed children over just fluoxetine use or CBT alone. As such, a combined treatment program may be the best treatment option for your child.

Which Psychiatric Medications Are Prescribed to Children?

Currently fluoxetine is the only medication approved for childhood major depressive disorder (MDD) in the United States. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), which increases the amount of serotonin in the body. Serotonin is a neurotransmitter (a chemical affecting brain functions) that is decreased in people with depression.

Additional medications to treat bipolar disorder such as lithium, tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) may also be prescribed. These drugs are less commonly used in children because of their potential adverse effects and limited knowledge about their effects in children. However, a review by Dr. Philip Hazell, published in 2002 in the Cochrane Database of Systematic Reviews, found that there was no benefit for treating children with TCAs before puberty. These drugs not only target serotonin, but also norepinephrine and dopamine, which are also imbalanced in depressed patients.

Warnings and Adverse Effects

In 2004, the FDA released a warning that SSRI use in children may put them at an increased risk for suicidal thoughts and behavior. However, in 2007, as a result of their investigation, the NIMH released a statement that the benefits of SSRI use in depressed children likely outweigh any risks. Additionally, the FDA explains that depression itself puts a child at an increased risk for suicidal thoughts and behavior.
SSRI medications have the potential to cause manic episodes in some children (and adults) with mood disorders, a state involving elevated, irritable or cycling moods. As such, it is important to monitor children for these symptoms.

Common adverse effects of SSRIs are headache, nausea, sleep problems and feeling jittery.

Adverse effects of tricyclic drugs may be dry mouth, blurred vision, constipation, difficulty urinating, low blood pressure and heart rate changes.

Any unusual or worsening adverse effects should immediately be discussed with your child's physician. Following the prescribed treatment plan is essential. Medication should only be taken as directed and never stopped without medical advice.

What to Expect

It may take a few weeks of medication use there to be signs of improvement, and 6 to 8 weeks for full impact. Chronic use of medication may not be necessary. Children on medication for depression should be closely monitored for improvement, adverse effects, and increased suicidal thoughts and behavior.

You can expect to take an active role in your child's medication regimen. Explaining to your child exactly what the medication is for and how it may affect him may relieve some anxiety. Developing a medication routine and incorporating something enjoyable may decrease resistance.

Communicating with your child's health care provider is important. If appropriate, involving your child's teachers or additional caregivers can help in providing a supportive and collaborative recovery effort.

Sources:

Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers. National Institute on Mental Health. Accessed: July 27, 2010. http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml

Antidepressant Use in Children, Adolescents, and Adults. U.S. Food and Drug Administration. Accessed: May 28, 2010. http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273

P. Hazell, D. O'Connell, D. Heathcote, D.A. Henry. "Tricyclic Drugs for Depression in Children and Adolescents." Database of Systematic Reviews. 2002 2

Prozac Medication Guide. Eli Lilly and Company. Accessed: June 28, 2010. http://www.prozac.com/Pages/index.aspx

S.B. E.A. O'Connor, Eder, M. Whitlock, E.P. "Screening for Child and Adolescent Depression in Primary Care Settings: A Systematic Evidence Review for the US Preventive Services Task Force." Pediatrics 4 Apr 09 123(4):e716-e735.

S.E. Son, J.T. Kirchner. "Depression in Children and Adolescents." American Family Physician 15 Nov 2000.

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