From the Guidelines
The best medication for depression in children is typically a selective serotonin reuptake inhibitor (SSRI), with fluoxetine (Prozac) being the first-line choice for most children and adolescents. Treatment usually begins with a low dose (10mg daily) and may be gradually increased if needed, with treatment continuing for at least 6-12 months after symptom improvement. Other SSRIs like sertraline (Zoloft) or escitalopram (Lexapro) may be considered if fluoxetine isn't effective or causes side effects. It's crucial to note that medication should be part of a comprehensive treatment approach that includes psychotherapy, particularly cognitive behavioral therapy. Parents should monitor for potential side effects, especially during the first few weeks, including increased suicidal thoughts, which is why the FDA has placed a black box warning on antidepressants for youth 1. Regular follow-up appointments (every 1-2 weeks initially) are essential to assess response and adjust treatment. Medication management should always be supervised by a child psychiatrist or pediatrician with expertise in mental health, as children's responses to antidepressants differ from adults and require specialized oversight.
Some key points to consider when treating depression in children with SSRIs include:
- Fluoxetine is FDA approved for treatment of MDD in children aged 8 years or older, and escitalopram is approved for treatment of MDD in adolescents aged 12 to 17 years 1.
- The use of SSRIs in children is associated with harms, specifically risk for suicidality, although the evidence on the harms of psychotherapy alone or in combination with SSRIs in children is limited 1.
- Collaborative care, which includes care managers to link primary care providers, patients, and mental health specialists, has been shown to be effective in reducing depressive symptoms in adolescents 1.
- Genetic variation, such as cytochrome P450 2D6 (CYP2D6) and cytochrome P450 2C19 (CYP2C19), may contribute to the differential risk-benefit ratio of SSRIs and provides a unique opportunity to develop pharmacogenetic guidelines for psychiatry 1.
From the FDA Drug Label
The efficacy of Prozac for the treatment of major depressive disorder was demonstrated in two 8– to 9–week placebo–controlled clinical trials with 315 pediatric outpatients ages 8 to ≤18 The efficacy of sertraline for the treatment of obsessive-compulsive disorder was demonstrated in a 12-week, multicenter, placebo-controlled study with 187 outpatients ages 6 to 17 Two placebo controlled trials (n=373) in pediatric patients with MDD have been conducted with sertraline, and the data were not sufficient to support a claim for use in pediatric patients
The best medication for depression in children is fluoxetine (Prozac), as it has demonstrated efficacy in two placebo-controlled clinical trials with pediatric outpatients ages 8 to ≤18 2.
- Key points:
- Fluoxetine has shown efficacy in treating major depressive disorder in pediatric patients.
- Sertraline has not shown sufficient evidence to support its use in pediatric patients with major depressive disorder, but it has been effective in treating obsessive-compulsive disorder in pediatric patients ages 6 to 17 3.
- The decision to use any medication in children should be made on a case-by-case basis, carefully considering the potential risks and benefits.
From the Research
Medication Options for Depression in Children
- The use of antidepressants in children younger than 10 years old is not definitively supported by research 4.
- Fluoxetine is suggested as a first-line agent for depressed adolescents who require psychopharmacological intervention 4.
- Antidepressant medication has been shown to reduce the chance of relapse or recurrence of depressive episodes in children and adolescents, with a lower relapse-recurrence rate of 40.9% compared to 66.6% with placebo 5.
Non-Pharmacological Interventions
- Non-pharmacological interventions, such as cognitive-behavioral therapy, can help improve symptoms of childhood mental health problems, including depression 6.
- These interventions should be considered as a primary approach for depressed children, and may include evaluation of potential parental psychiatric disorders 4.
Considerations for Treatment
- The decision to use antidepressant medication, such as fluoxetine, should be associated with specific social and health protocols to reinforce self-esteem, improve relationships, and facilitate healthy lifestyle changes 4.
- A risk-benefit analysis must be considered when prescribing selective serotonin reuptake inhibitors (SSRIs) to children and adolescents, due to the potential increased risk of suicidality 7.
- Primary care providers play an important role in identifying and treating children and adolescents with depression, and should be aware of the various treatment options available 8.