What should you do before your child starts taking an antidepressant?

It's important that your child have a thorough evaluation before he or she starts taking an antidepressant. A psychiatric evaluation by a psychiatrist — or a pediatrician or family physician who is experienced in the treatment of child and adolescent mood disorders — should include:

  • A detailed review of any potential risk factors your child may have that increase the risk of self-harm
  • An assessment of whether your child may have other mental illnesses, such as anxiety disorders, attention-deficit/hyperactivity disorder or bipolar disorder
  • An evaluation of whether there's a family history of mental illnesses or suicide

Which antidepressants can children take?

The FDA has approved certain antidepressants for use in children and teenagers for different types of diagnoses. Antidepressants come with a medication guide that advises parents and caregivers about risks and precautions. Be sure to carefully read the medication guide and package insert, and discuss any questions with the prescribing physician and your pharmacist.

FDA-approved antidepressants for children and teenagers
Medication* Age (in years) Diagnosis
Clomipramine (Anafranil) 10 and older Obsessive-compulsive disorder (OCD)
Duloxetine (Cymbalta) 7 and older Generalized anxiety disorder
Escitalopram (Lexapro) 12 and older Major depressive disorder
Fluoxetine (Prozac)
  • 8 and older
  • 7 and older
  • Major depressive disorder
  • OCD
Fluvoxamine 8 and older OCD
Olanzapine and fluoxetine, combination drug (Symbyax) 10 and older Bipolar depression
Sertraline (Zoloft) 6 and older OCD

*Many of these drugs are also available in generic form. Recommended initial dose and maximum dose vary by age.

Physicians may use their medical judgment to prescribe other antidepressants for children for what's called off-label use. This is a clinically common practice for many types of medications for both children and adults.

What should you do once your child starts taking an antidepressant?

The FDA advises that doctors prescribe the smallest quantity of pills possible to help reduce the risk of deliberate or accidental overdose. Careful monitoring by parents, caregivers and health care professionals is important for any child or teenager taking an antidepressant for depression or any other condition.

The highest risk of suicidal thinking and behavior occurs:

  • During the first few months of treatment with an antidepressant
  • When the dosage is increased or decreased

Parents and caregivers should closely observe the child on a daily basis during these transition periods and watch for worrisome changes for the whole time the child takes antidepressants.

The FDA also recommends that your child receive close monitoring by his or her health care professional during the first few months of treatment. Frequency of contact with doctors or mental health professionals depends on your child's needs. Make sure you stick to your child's recommended appointment schedule.

What warning signs should you watch for when your child is taking antidepressants?

Sometimes the signs and symptoms of suicidal thoughts or self-harm are difficult to see, and your child may not directly tell you about such thoughts. Here are some signs that your child's condition may be worsening or that he or she may be at risk of self-harm:

  • Talk of suicide or dying
  • Attempts to commit suicide
  • Self-injury
  • Agitation or restlessness
  • New or worsening anxiety or panic attacks
  • Irritability
  • Increasing sadness or worsening of depression symptoms
  • Impulsiveness
  • Extreme increase in talking, energy or activity
  • Aggression, violence or hostility
  • Trouble sleeping or worsening insomnia
  • Spending more time alone

Contact your child's health care professional right away if any of these signs occur, if they get worse, or if they worry you, your child, a teacher or other caregiver.

Make sure your child doesn't stop antidepressant treatment without the guidance of the prescribing doctor. Suddenly stopping an antidepressant may cause flu-like symptoms or side effects referred to as discontinuation syndrome.

What other treatment options are available for children with depression?

Most children who take antidepressants for depression will improve with medication. However, combining medication with talk therapy (psychotherapy) is likely to be even more effective. Many types of psychotherapy may be helpful, but cognitive behavioral therapy and interpersonal therapy have been scientifically studied and shown to be effective for treating depression.

  • Cognitive behavioral therapy. In cognitive behavioral therapy, a mental health professional can help your child improve coping skills, communication and problem-solving skills. Your child can also learn how to become aware of harmful ideas and behaviors, replace them with positive approaches, and manage emotions.
  • Interpersonal therapy. With a focus on relationships, this therapy may help your teenager adapt to changes in current relationships and develop new ones.

For some children and teenagers with mild symptoms, talk therapy alone may be beneficial.

May 27, 2016