Antidepressants are one of the most commonly prescribed medications for mental health issues — in adults and children alike. But are antidepressants safe for children?
The short answer: Antidepressants that have been well studied for children and adolescents are safe when taken as directed. Side effects vary from medication to medication, but most are manageable with a dose adjustment.
All antidepressants, however, carry a Food and Drug Administration black box warning of an increased risk of suicidal thoughts, feelings, and behavior in those under 25. This side effect is rare. A 2019 review of studies found no suicides in children and adolescents taking antidepressants.
It’s important to note that untreated depression and other psychiatric disorders are also a risk factor for suicide.
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Approved Antidepressants for Children
Antidepressants have a wider range of usage in adults than children. Antidepressants for children only gain FDA approval to treat a diagnosis of:
- Major depressive disorder
- Obsessive-compulsive disorder (OCD)
- Generalized anxiety disorder
- Childhood enuresis (uncontrolled bed-wetting)
Doctors often prescribe antidepressants in conjunction with traditional psychotherapy, such as talk therapy. These medications help balance abnormal or disrupted brain chemistry and signaling.
Seven antidepressants are approved by the FDA for children and adolescents, with specific age, dosing, and indication requirements. They include:
- Selective serotonin reuptake inhibitors, or SSRIs: Escitalopram (Lexapro), fluoxetine (Prozac), Fluvoxamine (Luvox), and Sertraline (Zoloft)
- Serotonin-norepinephrine reuptake inhibitors: Duloxetine (Cymbalta)
- Tricyclic antidepressants: Clomipramine (Anafranil) and Imipramine (Tofranil)
In children, research finds that SSRIs combined with cognitive behavioral therapy are the most likely path to improving symptoms and sending anxiety disorders and OCD into remission.
What to Expect With Children and Antidepressants
Your child’s doctor will prescribe a starting dose, which may increase after several weeks based on your child’s tolerance to achieve maximum efficacy with the fewest side effects.
It can take between one and two weeks to notice physical indications that the medication is working, such as an improvement in your child’s sleep, energy levels, and appetite. For children and teens with depression or anxiety, it may take up to eight weeks before their mood and activity level change, according to the National Alliance on Mental Illness. It may take between eight to 12 weeks to see improvement in OCD symptoms.
The first antidepressant your child takes may not be the best fit. It can take several months before doctors find the right antidepressant at the right dose. That’s why it’s important to monitor your child when they begin an antidepressant. Though rare, suicidal thoughts and behaviors are most likely to occur in the first weeks of starting an antidepressant, after switching antidepressants, or when dosing is adjusted. Notify your doctor immediately if your child experiences any suicidal thoughts or behavior.
Common Side Effects of Prozac and Other Antidepressants
Some of the most common side effects of antidepressants include:
- Nausea or upset stomach
- Dry mouth
- Increased sweating
- Sleep issues
Other serious effects include pediatric behavioral activation syndrome — severe agitation, hyperactivity, impulsivity, or possibly mania. Younger children are more likely than teens to experience these symptoms.
Side effects generally improve a week or two after first taking the medication. If they continue or get worse, doctors can lower the dose, recommend ways to manage the side effects, or prescribe a different antidepressant. Don’t stop taking an antidepressant without your doctor’s help. Stopping antidepressants abruptly can make symptoms worse.
Ultimately, are antidepressants safe for children? Yes. As long as you follow your doctor’s advice and monitor your child closely, your child should be able to use antidepressants to treat their mental health concerns safely.
For more information, visit UPMC Children’s Hospital of Pittsburgh online.
Current Psychiatry, Antidepressants for Pediatric Patients. Link
National Alliance on Mental Illness, What to Expect from Your Medications. Link
National Alliance on Mental Illness, Fluoxetine (Prozac). Link
Current Problems in Pediatric and Adolescent Health Care, Antidepressant-Induced Activation in Children and Adolescents: Risk, Recognition and Management. Link
Connect with UPMC
From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.