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Despite Antidepressant Fear, Depressed Kids Need Help

A new label on some antidepressants, a so-called black box warning, cautions that they may make kids feel more suicidal. But that warning shouldn't stop parents from considering their use for depressed teens, psychiatrists say.

In short, teen depression is a serious illness. The benefits of getting help, including taking medications if needed, far outweigh the potential risks.

Keeping watch

A specific group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) has been shown to help children and teens with depression, according to the National Institute of Mental Health (NIMH). The black box warning applies to these SSRIs and the U.S. Food and Drug Administration (FDA) says that suicidal thoughts or behavior are more likely in the first four weeks of use or when dosages are changed. Psychiatrists say the warning was meant, in part, to alert other doctors and parents to the need for closer monitoring.

The FDA says that children and teens who begin taking SSRIs should be closely watched for any worsening of depression, suicidal thoughts or behavior, or any unusual changes in behavior, including sleeplessness, agitation or withdrawal from social situations.

Antidepressants don't work in every case. Prozac, for example, helps only about two-thirds of those who take it, the FDA says, and some children experience side effects such as agitation.

Suicidal thoughts

Suicidal thoughts are very common in adolescents. Fortunately, few succeed. Usually, they don't tell anybody about it.

Studies involving about 4,400 depressed kids led to the new warning. Those who took antidepressants were twice as likely to express suicidal thoughts as those who took placebos (sugar pills). The numbers were small—4 percent for those on the drugs versus 2 percent on placebos. There were no actual suicides.

If you think your child might have depression, don't worry about trying to define what it is, just get it checked out. See a mental health professional and get a comprehensive evaluation. The good news is that if it is depression, most kids can be helped.

How parents can help

Here are some suggestions from the NIMH:

  • Realize that depression in your child or teen is a serious condition that should be treated and monitored.

  • Your child should be thoroughly evaluated by a health care provider to determine if medication is appropriate. If an SSRI is prescribed, the child should be closely monitored, particularly during the first four weeks. And if suicidal thoughts or agitation develop, notify your provider at once.

  • Medications are not the only treatment for depression, but are usually required if the depression is more than mild. Many times psychotherapy is given as the first treatment for mild forms of depression. For more severe forms, medication may be given in combination with psychotherapy.

  • If your child expresses suicidal thoughts or behavior or even intimates these, or has nervousness, agitation, irritability, sleeplessness or easily changeable moods, have him/her evaluated without delay.

  • If your child is already taking an SSRI, he/she should not stop taking the medication without discussing it with a health care provider. The child also should continue to be monitored to see that the medication is helping.

  • Realize that any medication may have side effects. Talk to your health care provider if you have concerns about side effects.