Harvard Mental Health Letter

Antidepressants for children and adolescents: An update

New research is shedding light on the hotly debated question of whether antidepressant medications developed for and tested mainly on adults can help many depressed children and adolescents — and whether some of these drugs may raise the risk of suicidal impulses and suicide attempts in young patients.

These questions are significant. A 2002 survey found that nearly 4% of American 13- to 19-year-olds and 1.4% of 6- to 12-year-olds were taking antidepressants. In the last few years, though, prescriptions have been declining as concerns about suicide have surfaced and culminated in warnings from the FDA.

A task force from the American College of Neuropsychopharmacology reviewed and analyzed the data from clinical trials of selective serotonin reuptake inhibitors (SSRIs), the most widely used prescription antidepressants. The task force found further evidence for the effectiveness of fluoxetine (Prozac), which was approved for the treatment of childhood depression in 2003. According to the report, fluoxetine may be superior to other SSRIs because it lingers longer in the body and therefore remains effective despite the missed doses that are more likely in youths than in adults. The task force says limitations in the design of studies might account for the reports of small differences in the rate of suicidal thoughts or gestures between patients taking antidepressants and those taking placebos.

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