Parents and professionals should be extremely cautious about using antidepressants with children. Not only is the evidence of their effectiveness poor at best, but children and teens are more susceptible to adverse reactions from these drugs.

Antidepressant prescriptions for children Fluoxetine (Prosac) is the only antidepressant that is FDA approved for treating children 8 years and older (Dopheide, 2006), though doctors routinely prescribe a number of other antidepressants that aren’t recommended. And even fluoxetine, though considered milder when compared to the other ones, still raises the suicide risk and comes with other side effects.

Do antidepressants work on children?

Neither SSRIs nor dual-reuptake inhibitors have shown much of an effect on pediatric depression in published research. The evidence that these drugs work on children or have any positive effect is described as “poor.” (Aebi, 2008) Sertraline proved no better than a placebo at treating depression in youth. (Wagner et al., 2003) There is no data whatsoever on treating youth depression for Venlafaxine, bupropion, nefazodone, trazodone, or mirtazapine – all dual-reuptake inhibitors. (Dopheide, 2006) Unfortunately, the doctors and psychiatrists prescribing these drugs rarely tell their patients that they are giving them a medication which has a “poor” chance of working.

Summing up the research, Dr. Robert Foltz of the Chicago School of Professional Psychology states: “The evidence base for [antidepressant] intervention rests on studies such as the 2004 Treatment of Adolescents with Depression Study. In this study of 439 youths, 109 were given fluoxetine (Prozac). Study conclusions reveal that in the short term, combined treatment of CBT [cognitive behavioral therapy] and fluoxetine resulted in the greatest advantage, followed by fluoxetien alone. But after the conclusion of the study (at 36 weeks), a one-year naturalistic follow-up shows the advantage of medication disappeared: participants from all arms of the treatment were in a virtual dead heat of programs on depression scores.

“Even more stunning than this deteriorating benefit are the efforts in substantiating SNRI medications, such as duloxetine (Cymbalta) or ventafaxine (Effexor). In a primary duloxetine study reported in the Cymbalta package literature, researchers found that efficacy in treating major depression was not demonstrated in patients aged seven to 17: neither Cymbalta nor an SSRI was superior to a placebo. In a major study of Effexor, the drug failed to outperform a placebo in two placebo-controlled trials of a total of 766 youths.

“Rather than subjecting the developing nervous system to these medications, clinicians should carefully reconsider their support for such interventions.” (In a letter to Scientific American Mind, May/June 2016, p. 5)

When should a child be put on an antidepressant?

Our personal view is that the use of antidepressants in children should be avoided at all costs and used only as a last-ditch effort in the most serious of cases (such as when a child’s life is at risk and no other options are available). Even then, the premise for such an intervention is shaky, since antidepressants actually INCREASE the suicide risk, and therefore may be even more dangerous than doing nothing. Our reluctance about treating kids with antidepressants is based on the following:

1. True depression in kids is a serious problem that needs fixing, and antidepressants CAN NOT and DO NOT fix this problem. Depression has never been shown to result from serotonin imbalances, so there isn’t a credible expert alive who will claim that these drugs fix depression…at best they merely coat over it. The most they will ever do is apply a band-aid to the problem. Putting a child on antidepressants avoids the underlying problem, it doesn’t deal with it. “Unfortunately, some families are looking for a quick fix but a pill is never going to get to the root of the problem,” says psychologist David Palmiter, who researches the effectiveness of antidepressants. (Lloyd, 2011 )

2. The mechanism for which antidepressants claim to work is rather dubious to say the least, and proper therapy routinely outperforms drugs, offering more durable solutions in ways that attack the source of the problem. Therefore drug treatments are far from the best option available.

3. The impact that these drugs have on the developing brain is grossly understudied, and the consequences we do know about from general research isn’t encouraging. Use of SSRIs throw a person’s healthy brain chemistry out of balance, so much so that the American Psychological Association recently created a new disorder just to deal with the chaos that occurs in trying to come down off these drugs. So not only are the benefits of antidepressants marginal to non-existent, but they come at the price of screwing up a child’s neurochemistry in a way that makes for bigger problems down the road. Antidepressants bring a child farther out of the range of normalcy, and may make it much harder for them to get healthy again.

4. The immediate side-effects are also substantial, and can include everything from lethargy and weight gain to suicidal tendencies. Many children have died because they were prescribed an antidepressant.

5. Depression is not created by any biological imbalance that antidepressants might treat, it is a disorder of thought. A psychological reaction to one’s circumstances. Circumstances + thought = depression. Even when people experience ongoing adversity, all the personal suffering in the world does not necessarily equal 1 ounce of depression. Depression only sets in when mental coping mechanisms that help people deal with adversity break down. Children, of all people, should have the least reason to be depressed. When they are, they need these coping mechanisms (and perhaps their circumstances) fixed. This doesn’t come in pill form. Antidepressants are to depression what alcohol is to depression: it’s a drug that may mask the bad feelings, but it doesn’t fix the source of their misery.

“Apprehensions about medication side effects make CBT a good first option for many children.”

– Michael Craig Miller, M.D. (2009, p. 8)

Guidelines on antidepressant use in children

This isn’t to say that there’s never a situation under which it might be appropriate to prescribe antidepressants to a child or adolescent, only that this approach should be taken only in cases of severe depression and ONLY alongside other forms of therapy and after all other options have been exhausted. If you still think an antidepressant is right for your child, we advise the following:

1. All children should start out on fluoxetine, since it is the most established SSRI and seems to show the lowest risk of adverse effects.

2. Monitor a child closely. The increased risk of suicide is the greatest in the first weeks and months after starting an SSRI, or when a child’s dosage is increased or decreased. Ask them how they are feeling and if they’ve had any strange thoughts.

3. Monitor your child for symptoms such as anxiety, panic attacks, agitation, irritability, hostility, impulsivity, severe restlessness, insomnia, hypomania or mania. These are signs that your child is responding poorly and could be developing manic depression, a common adverse side effect of antidepressants. Seek professional help immediately.