If your child is diagnosed with depression, you may have questions about the best ways to help. One difficult decision might be if you should put your child on antidepressant medication. You may wonder if these medications are safe, or if they will have side effects now or later in adulthood.
Graham Emslie, M.D., Child and Adolescent Psychiatrist at Children’s Health℠ and Professor at UT Southwestern, has conducted national research on antidepressants and is part of the team working to update the American Academy of Child and Adolescent Psychiatry’s Parent Guide on Depression Medications.
Below, he offers information and resources to help parents navigate common questions about treating depression in children and adolescents.
Diagnosing depression in children
Depression is a condition that can begin as early as age 3 and last throughout the teenage years and beyond. Dr. Emslie says diagnosing depression requires an evaluation that examines nine clinical factors, as well as a child’s functioning at home, at school and with peers. To be diagnosed with major depression, a child must have at least five of the nine symptoms during a two-week period, and at least one symptom must be depression, irritability, or decreased interest or pleasure. The symptoms include:
- Recurrent thoughts of death and suicide
- Diminished interest or pleasure in things once enjoyed
- Changes in appetite or weight loss/gain
- Anxiety or slowing down of thoughts or actions
- Fatigue (tired) or energy loss
- Feelings of worthlessness or inappropriate guilt
- Diminished ability to think/concentrate
- Insomnia (difficulty falling asleep or stay asleep) or hypersomnia (sleeping more than usual)
Because it can often be difficult to recognize symptoms of depression in children, Dr. Emslie says it’s important to watch for any of the above physical or behavioral changes. A pediatrician can also help you recognize the symptoms and offer recommendations for next steps.
Is medication always necessary?
No. Treatment plans for depression will depend on the severity. Several available treatment options can be tailored to fit the need of each child.
How do I know if my child needs antidepressants?
According to Dr. Emslie, doctors typically recommend antidepressants to help with moderate to severe depression. This must be based on a medical evaluation, the child’s needs and any additional treatment options that could benefit your child.
Before creating a treatment plan, psychiatrists look at the severity of depression and if other medical conditions are affecting the child. They also speak with the family and child to determine family history, daily activities, stressors and other factors that may be contributing to a child’s depression. These factors allow psychiatrists to tailor the plan of care to each child, including if antidepressants can help.
What other treatments for depression are available for kids?
For less severe depression, the psychiatrist may recommend ways to address stress as it contributes to depression before prescribing a specific treatment. Children may also benefit from specific talk therapy, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT). Moderate to severe depression may need a combination of medication and talk therapy.
Dr. Emslie reminds families that treatment is a sequence of choices. Talk to your doctor if something is concerning you or not working for your child.
Are antidepressants safe for children (under 18)?
Research shows that just like with adults, SSRIs (selective serotonin reuptake inhibitors) have been found safe and effective in children. SSRIs increase levels of serotonin in the brain and by blocking its reabsorption, making more serotonin available in the brain. Serotonin is involved in mood regulation and acts as a chemical messenger carrying signals between brain cells.
SSRIs are preferred to treat depression over previously prescribed medications, as they have fewer side effects and are less likely to be harmful if taken in an overdose.
Are there certain antidepressants that are safer for children than others?
Dr. Emslie notes there are a number of safe antidepressants available to treat depression. Fluoxetine is FDA-approved for children and adolescents and Escitalopram is FDA- approved for adolescents. Other SSRIs have also been found to be effective. A psychiatrist will recommend the best one for your child based on multiple clinical factors that will be addressed during treatment.
Also, Dr. Emslie cautions that there is no one-size-fits-all answer. The brain and a body’s unique chemistry interact differently with each medication. If one antidepressant isn’t effective, your child may be prescribed another until the most effective antidepressant is found.
Are there short-term or long-term side effects?
Just like with any medicine, side effects are possible. These can include headaches, stomach aches, agitation, restlessness and other symptoms. In rare occasions, it can cause changes in behavior like worsening depression or suicidal thoughts. Parents should contact their child’s psychiatrist immediately if your child experiences worsening of depression or suicidal thoughts, or if your child exhibits any unusual changes in behavior. To date, no studies have demonstrated long term side effects from antidepressant medications.
Dr. Emslie reminds parents to continue with regular visits with your psychiatrist during the initial stages of treatment. It’s an opportunity to talk through your child’s progress and share with the doctor your perspective on how treatment is working.
Will my child always need to take antidepressants?
Not necessarily. Dr. Emslie notes psychiatrists are specifically looking at the episode in childhood depression. If there are minimal to no symptoms for six to nine months (remission) after the episode, the doctor will consider tapering down the dosage and safely end the medication. If necessary, a child can restart the treatment later in life.
Should my child be involved in the decision to take antidepressants?
Yes. Dr. Emslie notes that the involvement depends on the age of the child. Ideally, he or she is able to understand what’s going on and actively participate in the decision. Children, especially adolescents, who are involved in their treatment are more likely to take medications and follow the care plan. Your doctor can help you talk to your child, especially a younger child, and explain the rationale for taking an antidepressant and what the child can expect.
Pediatric Psychiatrists at Children’s Health can help identify, manage depression in children and answer questions about antidepressants.