Although various antidepressant medications work in treating adults with depression, these medications may not be as effective in treating children and adolescents. Monitoring of medication therapy should be done very closely. A general paucity of scientific data is available regarding medication use in children and adolescents. In years past, it had been often presumed that medications worked in young people just like in adults. Clinical trials rarely included persons under the age of 18 years.
FDA approval for many psychotropic medications is strictly applicable to adult populations. Using many antidepressants in children and adolescents is therefore considered "off label." Before the develop ment of SSRIs, children and adolescents were rarely treated with antidepressants. The tricyclics and MAOIs that were available had possibly damaging side-effect profiles that outweighed the advantage of the treatment.
It was in part because of the fact that studies in persons under 18 didn't demonstrate antidepressants to be more effective than placebo. When SSRIs entered the marketplace, however, because of their better safety profile, prescriptions for antidepressants in children and adolescents increased dramatically.
There was clearly a need for safe, effective treatments, as in adults, untreated depression has serious adverse outcomes. In recent years, studies of SSRIs happen to be conducted in children and adolescent populations, with efficacy demonstrated in some. One observation from SSRI studies (that seemed to be noted in the early studies using tricyclics) was the presence of a relatively high placebo response rate.
Adolescents may benefit from the supportive contact with the treatment provider and thus "respond" to the placebo. Talk therapy is clearly essential for treating depression in children and adolescents, even if on medication. Currently, the only real SSRI with FDA approval for treatment of depression in pediatric populations is fluoxetine. Sertraline and fluvoxamine have FDA approval for treatment of pediatric obsessive-compulsive disorder.
Antidepressant therapy for kids and adolescents could be a difficult decision for many parents who are wary of starting a medication for emotional or behavioral problems. Many teens too are wary of taking medication for concern with being recognized as "crazy." Just like adults, the risk of taking medication should be balanced from the risk of forgoing medication treatment.
When it comes to children and adolescents, comprehending the risks of medication could be more difficult, however, due to the scarcity of research, as well as the evidence for higher placebo responses than in adults. Certainly, the seriousness of the depression must be taken into account when weighing the risks.
The more severe the depression is the slower the response might be to some talk therapy intervention alone. In addition, there has been recent concerns about the possibility of increased suicidal thinking in children and adolescents who are prescribed SSRIs.
A recent analysis through the FDA of all of the studies of newer antidepressants showed an interest rate of suicidal behaviors in 3% to 4% of kids and adolescents with depression who took an antidepressant along with a rate of 1% to 2% of these going for a placebo (inactive pill). Of note, there have been no deaths by suicide in the studies.
Also, there is no difference in the rate of suicidal behavior for all those being treated with an antidepressant for an anxiety disorder. The outcomes from the analysis have prompted the FDA to need a warning on all antidepressants concerning the risk of increased suicidal behavior (thoughts or actions) when used in children and adolescents.
While this is often disconcerting for any parent, you should keep in mind that the danger for suicide in untreated depression is approximately 15%. Reasons for the increased rate while on medication are closely related with a of factors, but it is not understood at the moment. What is important to keep in mind is the necessity for close monitoring. As in adults, depression is a condition that is associated with suicidality.
Whether with an antidepressant or not, patients need to become observed at close range for the onset of such symptoms or worsening of existing symptoms. Keeping the data in mind, in contrast to fears of increased suicidal tendencies, data from around the world actually document that the suicide rate among teenagers has dropped concordant with an increase of prescribing of SSRIs for depression.
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