Antidepressant Use In Children

By Karen Altsman, RPh.

It has become more common in recent years to see antidepressants prescribed for children. It is however, difficult to make a diagnosis since children sometimes have difficulty expressing their feelings. Symptoms of depression in children are similar to those seen in adults and include sadness, irritability, difficulty sleeping, weight-loss, suicidal thoughts and anti-social behavior.  If you see a decrease in desire for activities or school grades fall below expectations with no other explanation, you may consider the possibility of depression. After other causes are ruled out, such as thyroid disorder, infection, etc., a psychiatrist who has experience working with children may make a diagnosis of depression.

Medication should be a last resort after behavioral changes, environmental changes, and counseling are experienced. If the decision to begin an antidepressant is made, counseling should be continued in order to improve the success of both.

Treatment and Side Effects

The FDA has not approved all antidepressants for use in children.  This does not mean the drug cannot be used, rather the manufacturer has not done clinical trials in children in order to get FDA approval.  However, there may be enough use of the drug in children that some doctors feel comfortable prescribing it.

There are many different drugs to choose from. When deciding on the best antidepressant, the doctor will take several things into consideration, including prior experience with the drug in children, side effects, effectiveness, and cost. Even if one drug doesn’t improve symptoms, another drug may work well. The same is true for side effects.  If one drug causes side effects the child cannot tolerate, the physician may change them to another medication.

Side effects vary between individual drugs, but can include drowsiness, sleeplessness, agitation, nausea, diarrhea, constipation, headache, weight-gain and weight-loss. Some of these side effects seem to contradict one another.  While one drug may cause drowsiness in one person, in someone else it may cause sleeplessness. Because some of these side effects are unpredictable, coming up with a drug that is effective and has tolerable side effects is a trial and error process.

Treatment with an antidepressant should begin at the lowest possible dose and gradually increased to an effective dose.  Antidepressants usually take two to four weeks to see the maximum benefit. Do not discontinue the medication because you think it is not working, – give it a try for at least four weeks at the usual dose.

Once the child is on an effective drug, it should be continued for a year after symptoms are gone.  If major depression occurs two or more times during childhood and adolescence, treatment should be continued indefinitely.

When stopping the drug, it should be gradually decreased (weaning) to avoid severe depression or other side effects.

Parents should inform all healthcare providers (doctors, counselors, and pharmacists) of all medications (prescription, over the counter and “natural”) the child is taking.  This information will help to prevent drug interactions and decrease the likelihood of side effects.

Antidepressants can cause an increase in suicidal thoughts.  Suicidal thoughts and actions occur with depression as a disease, but there is a possibility that some of the drugs used to treat depression can actually increase these thoughts, especially in children.  Parents need to be in constant communication with their child and watch for any signs of increased depression, changes in thoughts, behaviors and moods. Watch for these signs especially when there is any change in dose or medication and for several months after.  If any behavioral changes occur, do not stop the medication, but call the doctor immediately. Be sure to read the medication guide that comes with each individual medication.

Antidepressants can be beneficial for children when counseling and environmental changes are not effective. Improvement in their social and academic success can be seen with appropriate treatment.  However, as with all medications, you and the doctor must weigh the benefits with the risks of the medication.

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Karen Altsman, RPh. Has been a Pharmacist at ValuMarket Pharmacy for 11 years.  She graduated from the University of Kentucky College of Pharmacy. She was the Kentucky Pharmacist’s Association Distinguished Young Pharmacist in 2001, as well as a Jefferson County Academy of Pharmacy Pharmacist of the Year and served as the Jefferson County Academy of Pharmacy Continuing Education Coordinator. She is married with three children. For more information, you can contact Karen at (502) 523-9707.

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