According to the National Institute of Mental Health, Major Depressive Disorder (MDD) affects about 5 percent of adolescents. Children with MDD exhibit more frequent suicidal thinking and behavior, and are more likely to abuse drugs or alcohol.

Fortunately, this depression is treatable, both with medication and with certain types of psychological therapies.

Selective serotonin reuptake inhibitors (SSRIs) have been shown to benefit adolescents and children (as well as adults) with depression. Non-SSRI antidepressants such as bupropion (Wellbutrin) and mittazapine (Remeron) are also useful treatment agents.

SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro) and fuvoxamine (Luvox), as well as the closely related antidepressant, venlafaxine (Effexor). Of these, only fluoxetine is approved by the FDA for use to treat depression in children age 8 and older. The others have been prescribed to children, but in “off-label” use.

In June 2003, the FDA recommended that paroxetine not be used in children and adolescents for the treatment of MDD.

Psychological therapies, such as cognitive-behavioral psychotherapy and interpersonal therapy, are another means of treating depression. They have been shown to be particularly effective in treating moderate to severe depression in adolescents when used in combination with antidepressant medication.

Studies have shown substantial benefits from medication treatment for adolescents with moderate to severe depression.

However, clinical trials have also shown that the rate of suicidal thinking or behavior, including actual suicide attempts, was 4 percent for those on SSRI medications, twice the 2 percent rate of those taking placebos.

These results prompted the FDA to issue a “black box” label warning regarding an increased risk for suicidal thoughts and behavior in children and adolescents treated with antidepressants.

There is no way of knowing who might be adversely affected by SSRIs. Many patients are helped substantially, some see little change, and a small percentage experience problems.

Given the adverse effects that some adolescents experience while taking SSRIs, parents should be strongly cautioned to watch their children closely for problematic symptoms. Urge parents and other caregivers to check their children daily for the following symptoms: increases in anxiety, agitation, insomnia, irritability, hostility, aggression, impulsivity and psychomotor restlessness, as well as the emergence of hypomania or mania and panic attacks.

This monitoring is especially important during the first four weeks of treatment.

If their child develops any of these symptoms, parents should consult their behavioral health caregiver or the prescribing physician immediately.

Children already on medication should remain on the drug if it has been helpful but should also be carefully monitored for side effects. Once started, treatment should not be stopped abruptly due to potential side effects, and families should not discontinue treatment without consulting their physician.

• SSRI medications usually have few side effects in adolescents and children, but for unknown reasons, some individuals experience agitation and abnormal behavior.
• Each child should be thoroughly evaluated by a physician to determine if medication is appropriate.
• Studies have shown the combination of fluoxetine and cognitive-behavioral therapy to be an effective treatment for adolescents with MDD.
• All patients should be followed closely throughout the treatment process to ensure the best possible result.

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Last Reviewed:  February 2, 2007