Children and Antidepressant Treatment

How should parents respond to the recent antidepressant clinical trials and the Food and Drug Administration’s monitoring warning? Untreated depression often causes suicide. But, is it safe for children to take antidepressants? We asked three of our child and adolescent advisory board clinicians how they address the issue.

Dr. William Beardslee, Physician-in-Chief and Chairman of the Department of Psychiatry at Children’s Hospital, author of Out of the Darkened Room: When a Parent is Depressed, Protecting the Children and Strengthening the Family.

Childhood depression is a serious, impairing illness, often missed because youngsters suffering from it may not complain much and gradually develop depression. Treatment starts with a clinician you trust. One who will answer any and all questions.

Talking therapies, (interpersonal and cognitive behavioral), and medication, have considerable promise, although we need much more research to know which therapy works for which kinds of depression. For severe depression, combined talk therapy and medication is likely to be best.

The FDA has rightly raised some concerns that some medications may increase risk of suicide, but this needs to be much more evaluation and research. For any treatment, the parent and the child must have their questions answered and know the risks and benefits of each treatment. They should know what to do if the depression persists, or appears to worsen.

Families should know that depression is a biological condition and that it is not anyone’s fault. But, that families involvement and collaboration is crucial for the child to improve.

Dr. David Fassler, MD, Child and Adolescent Psychiatrist, Trustee at Large of the American Psychiatric Association, author of Help Me I’m Sad.

Childhood and adolescent depression are very real illnesses, which affect a significant number of young people. Without treatment, children generally have trouble in school, at home and with their friends. They also think about suicide, make suicide plans, and attempt suicide at a significant rate. And each year, over 3000 children and adolescents actually do commit suicide.

With respect to antidepressants, my own opinion is that they can be extremely helpful for some children, but that medication alone is rarely an appropriate treatment for complex child psychiatric disorders, such as depression. It should only be used as part of an individualized treatment plan, which may also include individual therapy, family therapy, and work with the child’s school.

When considering any course of treatment, parents need to be advocates for their children. They should ask lots of questions, and if they have ongoing concerns, they should get a second opinion.

Mary A. Fristad, Ph.D., Professor of Psychiatry & Psychology, Director, Research & Psychological Services Division of Child & Adolescent Psychiatry, Ohio State University, author of Raising a Moody Child.

Depression is like taco sauce — it comes in mild, medium or hot varieties. A child or teen with mild depression may just need psychotherapy (talk therapy), whereas a person with severe depression may also need medication right away. It is important to tell the clinician about your family’s history of depression. Without a family history of depression, or if the depression started after a significant life stressor, talk therapy may be the best first step.

It is best to find a clinician experienced with mood disorders and skilled in working with patients your child’s age. Make sure you and your clinician carefully monitor the child throughout treatment. Know the warning signs for suicide and emerging mania (e.g., mood gets too “high” or silly, energy level goes through the roof, plans and actions start to go “over the top”), as well as adverse side effects of any medication taken.