The Medical Minute: Children and depression

May 05, 2004

By John Messmer
Penn State Milton S. Hershey Medical Center

The way the media reports it, you might think that antidepressants are dangerous, particularly in children. A few years ago, a Time magazine cover story reported on suicides in people taking Prozac and claims by Christian Science officials blaming the drug. Other stories suggested Prozac causes violence. Understandably, such reports might cause people to fear antidepressants. As usual, there is some truth to the stories, but along with the modicum of truth is also a great deal of exaggeration. Now media reports are saying antidepressants have not been found effective in children.

Depression in children is different than in adults. Part of the reason for that is children have less experience with depression and cannot verbalize their feelings. They don't recognize the bad feelings as depression. Even though they are less able to express it, children experience similar symptoms to adults -- sadness, apathy and lack of energy -- but in some children the only symptoms may be isolation or irritability. Schoolwork may suffer and discipline problems can develop.

Depression can be fatal -- suicide is the third-leading cause of death of teenagers in the United States. It is estimated that up to 25 percent of adolescents have been depressed by the time they reach their late teens and 6 percent may be depressed at any given time.

When anyone, child or adult, is profoundly depressed, it is not uncommon for them to consider suicide. Thoughts and comments about suicide are not necessarily signs of depression, but combined with moodiness, irritability, sadness and so on, the possibility that a child might act on the thought should prompt a visit to the child's physician. If you think your child is depressed, it's OK to ask about thoughts of suicide. You won't put the idea into his or her head and as a parent you need to know.

Once a child has been diagnosed with depression, there are several treatment options. In psychotherapy, a therapist helps the child to identify and discuss the depression in order to heal the psychologic issues that lead to depression. Psychotherapy takes time and is often combined with antidepressant medication. Medication can influence the brain chemistry to help a person begin to feel better.

Physicians have known for a long time that the early stages of depression treatment are risky. Early in recovery some children and adults who seemed to be improving may take their lives. A profoundly depressed person may want to die, but lacks the motivation to do it. As depression lifts and energy returns, an impulsive adolescent may act on his or her desire to stop the pain and take their own life.

That does not mean that antidepressants should not be used. Antidepressants used before Prozac were more dangerous since an overdose of the earlier drugs could be fatal. Prozac and others in the selective serotonin reuptake inhibitor (SSRI) class do not kill if overdosed. It's interesting to note that since the use of SSRIs began, there has been a significant decrease in adolescent suicide even though the media report on the occasional suicide of a person who was on an antidepressant.

The Food and Drug Administration has approved only Prozac for the treatment of depression in children 8 years and older. Zoloft, Luvox and Prozac have been approved for obsessive-compulsive disorder in children 8 and over. Lack of approval does not mean they should not be used. Physicians have used these and other SSRI's effectively for childhood depression for years.

To get FDA approval, a pharmaceutical company must test a drug in depressed children against those receiving placebo. Many people believe children cannot fully understand the informed consent process necessary to agree to be a part of a clinical trial, particularly the possibility they may not receive an active drug. Since children do not verbalize symptoms the same as adults, measuring benefit becomes more difficult. An effective drug may not show clear benefit. Consequently, pharmaceutical companies have been reluctant to invest money testing children.

So what's a parent to do? Children's moods change and sadness can accompany a life event, for example, the birth of a sibling, starting school and so on. If your child shows persistent sadness or withdraws often, schoolwork suffers or there is a return to early childhood behaviors, such as bed wetting, speak to your child's doctor. If medication is prescribed, ask about possible side effects and how your child should respond. Ask if counseling should be considered. If improvement is not seen ask if your doctor has considered another diagnosis.

Childhood depression is treatable and medication might be an effective component of treatment. For more information on depression in children and adolescents, visit http://www.nimh.nih.gov/HealthInformation/depchildmenu.cfm

(Media Contacts)

Last Updated March 19, 2009