If your child has been diagnosed with depression, you may be concerned about medication the doctor recommends. Or perhaps you suspect your child is depressed but want to know about treatment before you see a doctor.
It’s important to know that depression is a treatable medical condition. You may want to start with psychotherapy, such as cognitive behavioral therapy. Antidepressant drugs can also be very helpful in combination with psychotherapy. The drugs geared for children can cause some side effects. Learn about your options, how they work, and what possible side effects are.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are usually the first type of drugs a doctor will prescribe for a child’s depression. These drugs are taken just once a day and cause few side effects. They work by increasing the level of a chemical called serotonin in the brain. Low levels of serotonin have been linked to depression. Examples of SSRIs include:
- Fluoxetine (Prozac): Approved by the Food and Drug Administration (FDA) for kids age 8 and older
- Escitalopram (Lexapro): Approved by the FDA for kids age 12 and older
Other SSRIs may be prescribed for “off-label” use in children. Medications that are “off-label” may be safe and effective, even though they haven’t earned FDA approval. Off-label antidepressants include:
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
If a child doesn’t respond to SSRIs, her doctor may prescribe a different class of drugs called atypical antidepressants. They adjust levels of brain chemicals, which in turn boosts mood. Examples of atypical antidepressants are:
- Venlafaxine (Effexor)
- Desvenlafaxine (Pristiq)
- Duloxetine (Cymbalta)
- Mirtazapine (Remeron)
- Bupropion (Wellbutrin)
Another category of drugs is tricyclic antidepressants. Like other antidepressants, they adjust levels of brain chemicals, which boosts mood. Tricyclic antidepressants may cause more side effects than other types of antidepressants. For that reason, SSRIs and atypical antidepressants are usually tried first. Examples of tricyclic antidepressants are:
- Imipramine (Tofranil)
- Amitriptyline (Elavil)
- Desipramine (Norpramin)
- Nortriptyline (Pamelor)
- Clomipramine (Anafranil)
Side Effects of Antidepressant Medications
Antidepressant medications are usually well-tolerated. Be sure to discuss side effects with the doctor before your child starts taking these drugs.
SSRI medications often have fewer side effects than other antidepressants. Common side effects include changes in sleep (drowsiness or trouble sleeping) and digestive upset (such as nausea or diarrhea). However, there is some risk of manic behavior and increased suicidal thinking in kids taking SSRI medication (see below for more information).
Several atypical and tricyclic antidepressants have possible side effects that must be closely monitored by the doctor.
No matter what medication the doctor prescribes for your child, you can play it safe by following these tips:
- Make sure your child takes the medication only as directed. Antidepressant medications can be dangerous, even deadly, if taken in overdose.
- Always read the package insert that comes with your child’s prescription medication.
- Talk with the doctor or pharmacist about possible interaction with other medications, including over-the-counter cold and cough medicine.
How Long Side Effects Last
Most side effects aren’t serious and go away in the first few months of starting a drug. Even so, you should report any side effects to your child’s doctor. If your child develops rare side effects—such as fever or a rash—contact your child’s doctor immediately.
It’s also important to talk to your child’s doctor before stopping the medication. Some antidepressants (such as SSRIs) need to be decreased slowly, rather than stopped suddenly.
Antidepressants and the Risk of Suicide
An FDA review of research studies on SSRI medications found that there were no suicides among nearly 2,200 children treated with SSRI medications. However, 4 percent of the children had suicidal thoughts or even attempted suicide. That’s double the rate of those not taking antidepressants.
Due to the increased risk of suicide, the FDA has given SSRI antidepressants a “black box” label warning, the most serious type of warning for prescription drugs. The warning says children and adolescents taking SSRI medications should be closely monitored, especially during the first four to six weeks of treatment or whenever the dose is increased. This warning is clear in the medication package inserts given to patients.
How Long Antidepressants Take to Start Working
It can take four to six weeks for medication to relieve a child’s depression symptoms. If you don’t see results by then, check with the doctor. He may want to increase the dose or try another medication.
Help and Hope for Your Child
It can be tough to see your child struggle with depression. Fortunately, therapy and medication can often help ease your child’s depression. If your child doesn’t respond to treatment, or if he recovers but the depression returns, be sure to consult his doctor and therapist.