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Fall 2004

Studies Consider Use of Antidepressants in Children

As many as 5 percent of children meet diagnostic criteria for depression, with the incidence rising markedly after puberty. But the few studies that have addressed antidepressant medication use in children have yielded mixed results.

Compounding matters have been reports that selective serotonin reuptake inhibitors (SSRIs) may increase the risk of suicidal behavior in depressed children. The U.S. Food and Drug Administration (FDA), which has approved the use of fluoxetine for treating major depressive disorder in pediatric patients 8 years and older, requested earlier this year that labels on SSRIs include a warning that patients on these medications should be closely monitored. The FDA also announced that it is reviewing safety data on the use of antidepressants in children.

Recently, a large clinical study found that children with moderate to severe depression showed the most significant improvements in behavior when treated with medication (fluoxetine) or medication plus cognitive behavioral therapy.

“This study indicates that for chronic severe depression, there seems to be a benefit to treatment with SSRIs, but patients should be closely monitored,” says James McGough, M.D., child/adolescent psychiatrist at UCLA Neuropsychiatric Hospital. Candidates for SSRI treatment include children with unremitting sadness, irritability, and lack of joy that persists for several months and is consistent across different settings.

Even for children with more mild forms of depression, as well as those who fall short of the clinical diagnosis but show depressive symptoms, it’s important to address the problem early, often initially with psychotherapy, says Joan Asarnow, Ph.D., psychologist and director of UCLA’s Youth Stress and Mood Program.

“The earlier you catch the symptoms, the easier it is to reverse the negative spirals that can lead to full-blown disorders,” Dr. Asarnow notes.

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